Provider Demographics
NPI:1376874040
Name:O'HAGAN, ALISSA A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:A
Last Name:O'HAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 W ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-9200
Mailing Address - Country:US
Mailing Address - Phone:231-947-0404
Mailing Address - Fax:231-947-2190
Practice Address - Street 1:3960 W ROYAL DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-9200
Practice Address - Country:US
Practice Address - Phone:231-947-0404
Practice Address - Fax:231-947-2190
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301104030207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1376874040OtherNPI
FJ2442729OtherDEA