Provider Demographics
NPI:1588653620
Name:HAUCK, WARREN C (MD)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:C
Last Name:HAUCK
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 1:1 CAYLOR NICKEL SQ
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-2529
Mailing Address - Country:US
Mailing Address - Phone:260-919-3301
Mailing Address - Fax:260-919-3551
Practice Address - Street 1:1 CAYLOR NICKEL SQ
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2529
Practice Address - Country:US
Practice Address - Phone:260-919-3301
Practice Address - Fax:260-919-3551
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10126526207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100331550Medicaid
IN2015713001OtherCIGNA PROVIDER NUMBER
INP00785628OtherMEDICARE RR
IN000000084164OtherBCBS PROVIDER NUMBER
IN000000638215OtherANTHEM
OH3018979Medicaid
IN100006668OtherRAILROAD MEDICARE
IN4047089OtherAETNA PROVIDER NUMBER
IN100331550Medicaid
IN000000084164OtherBCBS PROVIDER NUMBER
IN264340CMedicare PIN