Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 125-053236 | IL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 4301103987 | MI |
NPI | 1124273958 |
---|---|
Provider Name | Dr. Thomas V O'hagan |
First Address | Traverse City, MI 49684-8965 |
Second Address | Traverse City, MI 49684-8965 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2008 |
Last Update Date | 26/03/2014 |