Provider Demographics
NPI:1487204863
Name:MIKAEL HAKANSSON, M.D. CORP.
Entity Type:Organization
Organization Name:MIKAEL HAKANSSON, M.D. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKANSSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-524-2749
Mailing Address - Street 1:533 SESPE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93015-1942
Mailing Address - Country:US
Mailing Address - Phone:805-524-2749
Mailing Address - Fax:805-524-6929
Practice Address - Street 1:533 SESPE AVE STE C
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-1942
Practice Address - Country:US
Practice Address - Phone:805-524-2749
Practice Address - Fax:805-524-6929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty