Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | RH002941 | MI |
NPI | 1003855107 |
---|---|
Provider Name | Dr. Robert Charles Hagemann |
First Address | Troy, MI 48083-5856 |
Second Address | Madison Hts, MI 48071-1844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 11/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T96982 | (02) | MI |