Organization
MICHAEL T. HEGSTROM,MD, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL TERRANCE HEGSTROM MD (PHYSICIAN)
(304) 327-1888
Entity
Organization
Contact information
Practice address
510 CHERRY STREET, SUITE 206, BLGD. A, BLUEFIELD, WV 24701-3341
(304) 327-1888
(304) 327-1889
Mailing address
510 CHERRY ST, SUITE 206, BLDG A, BLUEFIELD, WV 24701-3338
(304) 327-1888
(304) 327-1889
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
21695
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810001358
—
WV
Enumeration date
01/10/2007
Last updated
08/09/2011
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