Provider Demographics
NPI:1508873225
Name:HAAS, ERWIN JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:ERWIN
Middle Name:JOSEPH
Last Name:HAAS
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 1:2456 E COLLIER AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6103
Mailing Address - Country:US
Mailing Address - Phone:616-942-7674
Mailing Address - Fax:
Practice Address - Street 1:2456 E COLLIER AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6103
Practice Address - Country:US
Practice Address - Phone:616-942-7674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030861207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4866505Medicaid
MI1388898Medicaid
MIB44323Medicare UPIN
MI0412005Medicare ID - Type Unspecified