Provider Demographics
NPI:1477023216
Name:HAGERMAN, PRESTON JAMES
Entity Type:Individual
Prefix:
First Name:PRESTON
Middle Name:JAMES
Last Name:HAGERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E TUTTLE RD LOT 129
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-8624
Mailing Address - Country:US
Mailing Address - Phone:810-923-8682
Mailing Address - Fax:
Practice Address - Street 1:2925 BRETON RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-1745
Practice Address - Country:US
Practice Address - Phone:616-243-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other