Provider Demographics
NPI:1043767841
Name:HAIKEN, GAIL SHARON (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:SHARON
Last Name:HAIKEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 REGENTS PARK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5092
Mailing Address - Country:US
Mailing Address - Phone:815-397-2528
Mailing Address - Fax:
Practice Address - Street 1:5303 REGENTS PARK RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5092
Practice Address - Country:US
Practice Address - Phone:815-397-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0275822080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine