Individual
DR. SUSAN M HAGNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
146 E GENEVA SQ, LAKE GENEVA, WI 53147-9695
(262) 249-5005
(262) 249-7142
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
036-090050
IL
207V00000X
Obstetrics & Gynecology Physician
Primary
46010
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036090050 2
—
IL
05
—
34436900
—
WI
Enumeration date
11/02/2006
Last updated
10/06/2023
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