Provider Demographics
NPI:1558372185
Name:HAIGHT, MICHAEL ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLEN
Last Name:HAIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2625 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:559-443-2682
Mailing Address - Fax:559-443-2681
Practice Address - Street 1:726 N MEDICAL CENTER DR E STE 209
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6886
Practice Address - Country:US
Practice Address - Phone:559-325-5656
Practice Address - Fax:559-325-5568
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53221208000000X, 2080P0206X, 2080P0206X
NMMD2014-02112080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG53221OtherSTATE LICENSE
NMMD2014-0211OtherNEW MEXICO STATE LICENSE
WAMD60113701OtherWA STATE LIC