Provider Demographics
NPI:1245249192
Name:HAGEMAN, RONALD G (AUD CCCA)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:HAGEMAN
Suffix:
Gender:M
Credentials:AUD CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 E PARIS AVE SE
Mailing Address - Street 2:STE 170
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2459
Mailing Address - Country:US
Mailing Address - Phone:616-285-3733
Mailing Address - Fax:616-285-5960
Practice Address - Street 1:2505 E PARIS AVE SE
Practice Address - Street 2:STE 170
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2459
Practice Address - Country:US
Practice Address - Phone:616-285-3733
Practice Address - Fax:616-285-5960
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000046237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI640D115780OtherBCBS OF MICHIGAN
MI4956943OtherMEDICAID TYPE 90
MI4847180Medicaid
MI0P30810Medicare PIN