Provider Demographics
NPI:1538120282
Name:HAGEN, HEIDI C (DPM)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:C
Last Name:HAGEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9119 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2229
Mailing Address - Country:US
Mailing Address - Phone:913-677-3600
Mailing Address - Fax:913-432-7624
Practice Address - Street 1:1956 NW COPPER OAKS CIR
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-8300
Practice Address - Country:US
Practice Address - Phone:816-228-6995
Practice Address - Fax:816-228-8672
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00287213ES0131X
MO000627213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO24240033OtherBLUE CROSS BLUE SHIELD MO
MO400719OtherBLUE SHIELD TOPEKA
KS400719OtherBLUE SHIELD TOPEKA
KS24240023OtherBLUE CROSS BLUE SHIELD
KS24240023OtherBLUE CROSS BLUE SHIELD
MO24240033OtherBLUE CROSS BLUE SHIELD MO
MOU16486Medicare UPIN
KSP00011187Medicare ID - Type UnspecifiedRAIL ROAD
KSN859810Medicare ID - Type Unspecified
KSU16486Medicare UPIN