Provider Demographics
NPI:1154761971
Name:HASEGAWA, MICHAEL KOICHI (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KOICHI
Last Name:HASEGAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 BEE CAVES RD
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5221
Mailing Address - Country:US
Mailing Address - Phone:512-524-7783
Mailing Address - Fax:
Practice Address - Street 1:5100 BEE CAVES RD
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5221
Practice Address - Country:US
Practice Address - Phone:512-524-7783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125063470207P00000X
TXQ6753207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine