Provider Demographics
NPI:1134112113
Name:HASLITT, JOSEPH HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HOWARD
Last Name:HASLITT
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 1:2701 W NORTH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3415
Mailing Address - Country:US
Mailing Address - Phone:765-287-0248
Mailing Address - Fax:765-287-0265
Practice Address - Street 1:2701 W NORTH ST
Practice Address - Street 2:SUITE B
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3415
Practice Address - Country:US
Practice Address - Phone:765-287-0248
Practice Address - Fax:765-287-0265
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030816207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000084788OtherBLUE SHIELD
IN1001888008Medicaid
IN205370Medicare PIN
B28559Medicare UPIN