Provider Demographics
NPI:1336115575
Name:HAAKENSON, ROBERT CARL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CARL
Last Name:HAAKENSON
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 1:308 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:OLIVIA
Mailing Address - State:MN
Mailing Address - Zip Code:56277-1225
Mailing Address - Country:US
Mailing Address - Phone:320-523-5129
Mailing Address - Fax:
Practice Address - Street 1:308 S 13TH ST
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-1225
Practice Address - Country:US
Practice Address - Phone:320-523-5129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18578207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA01205Medicare UPIN