Provider Demographics
NPI:1780603746
Name:HAGENSEE, MICHAEL EDWARD (MD PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
Last Name:HAGENSEE
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 BOLIVAR ST
Mailing Address - Street 2:LSUHSC
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1349
Mailing Address - Country:US
Mailing Address - Phone:504-903-6569
Mailing Address - Fax:504-903-6842
Practice Address - Street 1:136 S ROMAN ST
Practice Address - Street 2:LSUHSC
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-3095
Practice Address - Country:US
Practice Address - Phone:504-903-6569
Practice Address - Fax:504-903-6842
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12021R207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA53234Medicaid
MS02558050Medicaid
LA1532347Medicaid
LA80387OtherLSUHSC
LA278093YH3UMedicare PIN
LA53234Medicaid
LA1532347Medicaid
LAP00158622Medicare PIN
LA5Y379Medicare PIN