Individual
SVETLANA V HAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
885 W CONNEXION WAY STE 200, COLUMBIA CITY, IN 46725-1045
(260) 248-9260
(260) 248-9279
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01069906A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000769229
ANTHEM
IN
05
—
201026380
—
IN
Enumeration date
06/17/2009
Last updated
10/20/2022
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