Provider Demographics
NPI:1619359510
Name:HAGMANN, KATHERINE ALTA (DPM)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ALTA
Last Name:HAGMANN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11390 E VIA LINDA STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-4075
Mailing Address - Country:US
Mailing Address - Phone:480-247-8443
Mailing Address - Fax:480-292-9381
Practice Address - Street 1:11390 E VIA LINDA STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-4075
Practice Address - Country:US
Practice Address - Phone:480-274-8443
Practice Address - Fax:480-292-9381
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1045213ES0103X
IL135.000879213ES0103X
AZPOD-001093213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery