Basic Information
| Provider Information | |||||||||
| NPI: | 1487204863 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIKAEL HAKANSSON, M.D. CORP. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 533 SESPE AVE STE C | ||||||||
| Address2: | |||||||||
| City: | FILLMORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930151942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055242749 | ||||||||
| FaxNumber: | 8055246929 | ||||||||
| Practice Location | |||||||||
| Address1: | 533 SESPE AVE STE C | ||||||||
| Address2: | |||||||||
| City: | FILLMORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930151942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055242749 | ||||||||
| FaxNumber: | 8055246929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2019 | ||||||||
| LastUpdateDate: | 09/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | HAKANSSON | ||||||||
| AuthorizedOfficialFirstName: | MIKAEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8055242749 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.