Provider Demographics
NPI:1518989383
Name:HARALDSEN, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:HARALDSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5577 N ORACLE RD
Mailing Address - Street 2:S 103
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3821
Mailing Address - Country:US
Mailing Address - Phone:520-293-9100
Mailing Address - Fax:520-293-8654
Practice Address - Street 1:5577 N ORACLE RD
Practice Address - Street 2:S 103
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3821
Practice Address - Country:US
Practice Address - Phone:520-293-9100
Practice Address - Fax:520-293-8654
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ9467207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000BGNBTMedicare ID - Type Unspecified
AZZOOOOBGNBTMedicare PIN
C99614Medicare UPIN