Provider Demographics
NPI:1811989650
Name:HAGEN, JOSEPH N (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:N
Last Name:HAGEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31500 TELEGRAPH RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4313
Mailing Address - Country:US
Mailing Address - Phone:248-593-0575
Mailing Address - Fax:877-402-0581
Practice Address - Street 1:31500 TELEGRAPH RD
Practice Address - Street 2:SUITE 150
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4367
Practice Address - Country:US
Practice Address - Phone:248-593-0575
Practice Address - Fax:877-402-0518
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI446975711Medicaid
MI5101012230OtherCONTROLLED SUBSTANCE
MI446975711Medicaid