Individual
KYLE JAY HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10000 W BLUEMOUND RD, WAUWATOSA, WI 53226-4321
(414) 805-5320
(414) 805-5323
Mailing address
10000 W BLUEMOUND RD, WAUWATOSA, WI 53226-4321
(414) 805-5320
(414) 805-5323
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4038
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578093258
—
WI
Enumeration date
06/15/2017
Last updated
04/03/2025
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