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Individual

MICHAEL JOSEPH HAGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-5015
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
11885646-1205
UT
207R00000X
Internal Medicine Physician
Primary
M-16384
ID

Other

Enumeration date
04/01/2019
Last updated
07/18/2022
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