Provider Demographics
NPI:1376547117
Name:HAASE, TAGE (MD)
Entity Type:Individual
Prefix:DR
First Name:TAGE
Middle Name:
Last Name:HAASE
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 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-781-5111
Mailing Address - Fax:
Practice Address - Street 1:484 GOLDEN AUTUMN WAY STE 201
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-6913
Practice Address - Country:US
Practice Address - Phone:270-783-3307
Practice Address - Fax:270-780-0491
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38300208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64064025Medicaid
KY000000284789OtherANTHEM
KY64064025Medicaid
KY50006909OtherPASSPORT
KYH24646Medicare UPIN
KY000000284789OtherANTHEM