Individual
JEFFREY C HAGEDORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2138 25TH ST STE F, COLUMBUS, IN 47201-3241
(812) 376-3100
(812) 378-6191
Mailing address
PO BOX 775383, CHICAGO, IL 60677-5383
(812) 376-5315
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01028132A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000990875
ANTHEM PIN
IN
05
—
100138970
—
IN
01
—
P01163092
RAILROAD MEDICARE
IN
Enumeration date
05/26/2006
Last updated
09/09/2024
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