Provider Demographics
NPI:1780791699
Name:HAGEMANN, CARRIE A (DO)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:A
Last Name:HAGEMANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W. MARKET
Mailing Address - Street 2:SUITE B
Mailing Address - City:OSAGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66523
Mailing Address - Country:US
Mailing Address - Phone:785-528-3161
Mailing Address - Fax:785-528-4045
Practice Address - Street 1:131 W. MARKET
Practice Address - Street 2:SUITE B
Practice Address - City:OSAGE CITY
Practice Address - State:KS
Practice Address - Zip Code:66523
Practice Address - Country:US
Practice Address - Phone:785-528-3161
Practice Address - Fax:785-528-4045
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-32170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200402620AMedicaid
KS067350OtherMEDICARE PTAN
KSI61031Medicare UPIN