Provider Demographics
NPI:1124018213
Name:HAUPERT, MICHAEL S (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:HAUPERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 320C
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3604
Mailing Address - Country:US
Mailing Address - Phone:248-571-3600
Mailing Address - Fax:248-973-8560
Practice Address - Street 1:7001 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 320C
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3604
Practice Address - Country:US
Practice Address - Phone:248-571-3600
Practice Address - Fax:248-973-8560
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010352207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4189280Medicaid
MI4189299Medicaid
MI4606981Medicaid
MI040E011990OtherBCBS OF MI
MI4189305Medicaid
MIP35120087Medicare PIN
MI0N10480003Medicare PIN
MI040E011990OtherBCBS OF MI
MI4189305Medicaid