Provider Demographics
NPI:1154320117
Name:HAUK, MICHAEL E (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:HAUK
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 1:201 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16550-0002
Mailing Address - Country:US
Mailing Address - Phone:814-877-6182
Mailing Address - Fax:814-877-6149
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-6182
Practice Address - Fax:814-877-6149
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006565L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA300126202OtherRR MEDICARE
PA302495OtherUPMC
PA0016413790021Medicaid
00025196502OtherUNIVERA
PA070977OtherUNISON - HAMOT RADIOLOGY
PA1521112OtherGATEWAY
PA147525OtherUNISON - IMAGING CENTER
PA902479OtherBLUE SHIELD
NY01796890OtherNY MEDICAL ASSISTANCE
OH2058731OtherOH MEDICAL ASSISTANCE
PA3050654OtherAETNA
PA0016413790021Medicaid
PA902479E7CMedicare PIN