Individual
DEAN DAVID HAGEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1416 PRAIRIE AVE, BELLEVILLE, IL 62220-3681
(618) 235-5998
Mailing address
1416 PRAIRIE AVE, BELLEVILLE, IL 62220-3681
(618) 235-5998
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036049165
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36049165
—
IL
Enumeration date
11/17/2011
Last updated
11/17/2011
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