Provider Demographics
NPI:1568578250
Name:DE HAAS, DIRK R (MD)
Entity Type:Individual
Prefix:
First Name:DIRK
Middle Name:R
Last Name:DE HAAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3001 GREEN BAY ROAD MAIL CODE 111
Mailing Address - Street 2:NORTH CHICAGO VA MEDICAL CENTER EMERGENCY DEPARTMENT
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064
Mailing Address - Country:US
Mailing Address - Phone:847-688-1900
Mailing Address - Fax:
Practice Address - Street 1:3001 GREEN BAY ROAD MAIL CODE 111
Practice Address - Street 2:NORTH CHICAGO VA MEDICAL CENTER EMERGENCY DEPARTMENT
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064
Practice Address - Country:US
Practice Address - Phone:847-688-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301511346207P00000X
RIMD18064207P00000X
NJ25MA11265100207P00000X
CAA61437207P00000X
NY304406207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG63183Medicare UPIN