Basic Information
| Provider Information | |||||||||
| NPI: | 1346770229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAGLIN | ||||||||
| FirstName: | KRYSTINE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MOULTON | ||||||||
| OtherFirstName: | KRYSTINE | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1205 SILVER RIDGE LN | ||||||||
| Address2: | |||||||||
| City: | BROWNSBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461128142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203942521 | ||||||||
| FaxNumber: | 2488495324 | ||||||||
| Practice Location | |||||||||
| Address1: | 11725 ILLINOIS ST STE 140 | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460323010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176883700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207VF0040X | 01085809A | IN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
No ID Information.