Provider Demographics
NPI:1386688174
Name:HAAG, CHERYL A
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:A
Last Name:HAAG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4957 SWINYAR DR
Mailing Address - Street 2:STE 105
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 1:4957 SWINYAR DR
Practice Address - Street 2:STE 105
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-2205
Practice Address - Country:US
Practice Address - Phone:423-396-3668
Practice Address - Fax:423-396-2436
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-002120-L213ES0103X
TNDPM0000000676213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3350018OtherPROVIDER TRANSACTION ACCESS NUMBER
PA110736Other'PA HIGHMARK' MEDICARE
PA110736Other'PA HIGHMARK' MEDICARE
PA0182760002Medicare NSC