Individual
JOHN A HAGGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16901 LAKESIDE HILLS CT, ALEGENT LAKESIDE HOSPITAL DEPT OF RADIOLOGY, OMAHA, NE 68130-2318
(402) 717-8000
Mailing address
PO BOX 4460, OMAHA, NE 68104
(886) 491-5807
(913) 491-0411
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
20553
NE
2085R0202X
Diagnostic Radiology Physician
31859
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14706
LICENSE #
NE
05
—
2165159
—
IA
05
—
3165159
—
IA
01
—
31859
LICENSE #
IA
01
—
35328
BCBS
NE
01
—
40621
BCBS
IA
05
—
4165159
—
IA
05
—
5165159
—
IA
05
—
6165159
—
IA
01
—
821
MIDLANDS
—
01
—
BH4712851
CONTROLLED SUBSTANCE
IA
Enumeration date
06/20/2006
Last updated
03/07/2023
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