Provider Demographics
NPI:1518351378
Name:HAAG FOOT AND ANKLE PLLC
Entity Type:Organization
Organization Name:HAAG FOOT AND ANKLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:423-396-3668
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 1:4957 SWINYAR DR STE 105
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM00000000676213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1518351378OtherNPI
TNQ019161Medicaid
TN1513514Medicaid