Hagenow, Charles Frederick

Hagenow, Charles Frederick is an individual health care provider with primary practice located at 714 N Michigan St , South Bend IN 46601-1035. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Hagenow, Charles Frederick can be contacted via phone (574) 647-7477.

Contact Information

Primary practice address
714 N Michigan St South Bend IN 46601-1035
Phone: (574) 647-7477
Fax: (574) 647-3655
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01024048A Indiana

Profile Details

NPI number 1568450732
LBN Legal business name Hagenow, Charles Frederick
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 11th, 2005
Last updated Mar 30th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568450732 NPPES
Indiana MEDICAID 100364800

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