Provider Demographics
NPI:1043398464
Name:HAUGHEY, CAROL THERESE (PA)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:THERESE
Last Name:HAUGHEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:HESS HAUGHEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1050 LEGION DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122
Mailing Address - Country:US
Mailing Address - Phone:262-782-8272
Mailing Address - Fax:262-782-5420
Practice Address - Street 1:1050 LEGION DRIVE
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122
Practice Address - Country:US
Practice Address - Phone:262-782-8272
Practice Address - Fax:262-782-5420
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI311023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30477700Medicaid
WI68371Medicare ID - Type Unspecified
WI30477700Medicaid