Individual
JONATHAN E HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 MEADOW ROW CT, APPLETON, WI 54913-9511
(920) 850-2023
Mailing address
55 MEADOW ROW CT, APPLETON, WI 54913-9511
(920) 850-2023
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28526-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31510400
—
WI
Enumeration date
09/15/2005
Last updated
03/29/2019
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