Basic Information
| Provider Information | |||||||||
| NPI: | 1780603746 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAGENSEE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | MD PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 533 BOLIVAR ST | ||||||||
| Address2: | LSUHSC | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701121349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049036569 | ||||||||
| FaxNumber: | 5049036842 | ||||||||
| Practice Location | |||||||||
| Address1: | 136 S ROMAN ST | ||||||||
| Address2: | LSUHSC | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701123095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049036569 | ||||||||
| FaxNumber: | 5049036842 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 11/07/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 12021R | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 53234 | 05 | LA | MEDICAID | 02558050 | 05 | MS | MEDICAID | 1532347 | 05 | LA | MEDICAID | 80387 | 01 | LA | LSUHSC | OTHER |