Provider Demographics
NPI:1427080282
Name:HEGEWALD, MICHAEL G (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:HEGEWALD
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 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:360-830-1601
Mailing Address - Fax:
Practice Address - Street 1:2011 NW MYHRE PL
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8561
Practice Address - Country:US
Practice Address - Phone:360-830-1601
Practice Address - Fax:360-830-1696
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028486207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4239193OtherAETNA
WA8129660Medicaid
HE6514OtherREGENCE BLUE SHIELD
060016785OtherRAILROAD MEDICARE
WA79379OtherLABOR & INDUSTRIES
WA79379OtherLABOR & INDUSTRIES
WAG8852220Medicare PIN
WAG000250411Medicare PIN
WAG115136420Medicare PIN
E98313Medicare UPIN
WAG000250625Medicare PIN
WAGAB05677Medicare PIN
WAGAB05624Medicare PIN