Provider Demographics
NPI:1083847644
Name:MICHAEL R HAAG, DPM, ATC, LLC
Entity Type:Organization
Organization Name:MICHAEL R HAAG, DPM, ATC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:HAAG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-885-0866
Mailing Address - Street 1:5311 LIMESTONE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1246
Mailing Address - Country:US
Mailing Address - Phone:302-234-3907
Mailing Address - Fax:302-234-3927
Practice Address - Street 1:5311 LIMESTONE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1246
Practice Address - Country:US
Practice Address - Phone:302-234-3907
Practice Address - Fax:302-234-3927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000189261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
6400810001Medicare NSC