Provider Demographics
NPI:1174044010
Name:HAAG, KEVIN TIMOTHY (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:TIMOTHY
Last Name:HAAG
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:4957 SWINYAR DR STE 105
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-2205
Mailing Address - Country:US
Mailing Address - Phone:423-396-3668
Mailing Address - Fax:423-396-2436
Practice Address - Street 1:9325 APISON PIKE STE 137
Practice Address - Street 2:
Practice Address - City:COLLEGE DALE
Practice Address - State:TN
Practice Address - Zip Code:37363-3805
Practice Address - Country:US
Practice Address - Phone:423-396-3668
Practice Address - Fax:423-396-2436
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5901002704213E00000X
TN877213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist