Individual
PATRICIA IVONNE HAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
801 S 70TH ST, WEST ALLIS, WI 53214-3147
(414) 773-6600
(414) 773-6656
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CSMCP CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(414) 773-6600
(414) 773-6656
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
40944
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32606100
—
WI
01
—
7310019
AETNA
WI
01
—
7590215
CIGNA
WI
01
—
810127302
PRIVATEHEALTHCARE SYSTEM
WI
Enumeration date
06/21/2005
Last updated
06/11/2012
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