Provider Demographics
NPI:1073650206
Name:KRIS A HAASE DPM PLC
Entity Type:Organization
Organization Name:KRIS A HAASE DPM PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAASE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-666-8807
Mailing Address - Street 1:7611 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1503
Mailing Address - Country:US
Mailing Address - Phone:248-666-8807
Mailing Address - Fax:248-666-7709
Practice Address - Street 1:7611 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1503
Practice Address - Country:US
Practice Address - Phone:248-666-8807
Practice Address - Fax:248-666-7709
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KRIS A HAASE DPM PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-30
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKH001672332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480033238OtherRAILROAD MEDICARE
MI4856359200OtherBLUE CROSS/BCN
MI4797510001OtherDME
MI0P32320Medicare ID - Type UnspecifiedMEDICARE
MIT95282Medicare UPIN
MI1073650206Medicare NSC