Provider Demographics
NPI:1487757399
Name:HAGEDORN, CURT H (MD)
Entity type:Individual
Prefix:DR
First Name:CURT
Middle Name:H
Last Name:HAGEDORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF UTAH SCHOOL OF MEDICINE
Mailing Address - Street 2:30 N 1900 E, ROOM 4R118
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-581-7803
Mailing Address - Fax:801-585-0187
Practice Address - Street 1:UNIVERSITY OF UTAH SCHOOL OF MEDICINE
Practice Address - Street 2:30 N 1900 E, ROOM 4R118
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-7803
Practice Address - Fax:801-585-0187
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-30483207RG0100X, 207RI0008X
UT6633685-8017207RG0100X
UT6633685-8018207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS466570OtherFIRSTGUARD
KS200005150AMedicaid
MO208459008Medicaid
MO33271012OtherBCBS KC
KSP00112715Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MO33271012OtherBCBS KC
F64624Medicare UPIN