Provider Demographics
NPI:1609929462
Name:HAGLE, TODD S (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:S
Last Name:HAGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 REMINGTON BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5817
Mailing Address - Country:US
Mailing Address - Phone:630-226-1130
Mailing Address - Fax:630-226-1134
Practice Address - Street 1:2210 DEAN ST STE K
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1059
Practice Address - Country:US
Practice Address - Phone:630-223-1130
Practice Address - Fax:630-226-1134
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111605208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111605Medicaid
IL201133022 KANEMedicare PIN
ILI19310Medicare UPIN
IL207003004 COOKMedicare PIN
INM400054540Medicare UPIN