Provider Demographics
NPI:1164992194
Name:HAASE, KONRAD JOESEPH
Entity Type:Individual
Prefix:MR
First Name:KONRAD
Middle Name:JOESEPH
Last Name:HAASE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 RUDOLPH DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-1548
Mailing Address - Country:US
Mailing Address - Phone:262-307-5220
Mailing Address - Fax:
Practice Address - Street 1:3153 RUDOLPH DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-1548
Practice Address - Country:US
Practice Address - Phone:262-307-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment