Provider Demographics
NPI:1124009055
Name:DE HAAN, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:DE HAAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 HUGHES AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-1836
Mailing Address - Country:US
Mailing Address - Phone:206-938-1419
Mailing Address - Fax:
Practice Address - Street 1:16251 SYLVESTER RD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3017
Practice Address - Country:US
Practice Address - Phone:206-244-1212
Practice Address - Fax:206-244-1223
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025426207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0165305OtherDEPT OF LABOR & INDUSTRIE
WA1053479Medicaid
WA5628DEOtherREGENCE BLUE SHIELD
WA8934230OtherCRIME VICTIMS PGM
WA1053479Medicaid
WA8934230OtherCRIME VICTIMS PGM
WA5628DEOtherREGENCE BLUE SHIELD