Hagedorn, Brett Alan

Hagedorn, Brett Alan is an individual health care provider with primary practice located at 5001 Us Highway 30 W Ste D , Fort Wayne IN 46818-9701. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Hagedorn, Brett Alan can be contacted via phone (260) 432-1568.

Contact Information

Primary practice address
5001 Us Highway 30 W Ste D Fort Wayne IN 46818-9701
Phone: (260) 432-1568
Fax: (260) 432-4969
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 01048463 Indiana

Profile Details

NPI number 1275504458
LBN Legal business name Hagedorn, Brett Alan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 27th, 2006
Last updated Jun 17th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275504458 NPPES
Indiana MEDICAID 200179850
Indiana MEDICAID 2068604
Indiana MEDICAID 1275504458

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