Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | IL | |
N | 1223X0400X | Orthodontists | IL |
NPI | 1013129436 |
---|---|
Provider Name | Dr. Michael Anthony Hage |
First Address | Decatur, IL 62526-1586 |
Second Address | Decatur, IL 62526-1586 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2007 |
Last Update Date | 08/07/2007 |