Mitchell Hagen, MD

Primary specialty

Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X

License

73195 Issued in MN

Practice address

935 Wayzata Blvd E Ste 200
Wayzata, MN 55391-2513

Phone

(763) 220-8030

NPI assigned

Apr 17, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1053808931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "935 WAYZATA BLVD E STE 200",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553912513",
            "telephone_number": "763-220-8030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 WAYZATA BLVD E STE 200",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553912513",
            "telephone_number": "763-220-8030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEN",
        "first_name": "MITCHELL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-17",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "MN",
            "license": "73195",
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "321271",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aarti Goyal, DC
• Dean S. Grauds, M.A.,
• Vian Maureen Gredvig, MSW, LICSW
• Connie J Greenberg, M.A., L.P.
• Patricia Yarnes Hadley, D.C.
• Hakim Medical Enterprises, P.a.
• Hammer Residences, Inc
• Hammer Residences, Inc.
• Hammer Residences, Inc.
• Hannon Dental, P.L.L.C.

• Otolaryngology/Facial Plastic Surgery Physician in Wayzata, MN
• Providers in Wayzata, MN by specialty
• Otolaryngology/Facial Plastic Surgery Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.