Provider Demographics
NPI:1609855873
Name:HAUGO, AMIE C (MD)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:C
Last Name:HAUGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 8TH ST S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-3604
Mailing Address - Country:US
Mailing Address - Phone:701-234-3260
Mailing Address - Fax:
Practice Address - Street 1:1301 8TH ST S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-3604
Practice Address - Country:US
Practice Address - Phone:701-234-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN465041700Medicaid
ND14549Medicaid
NDP00461196Medicare PIN
ND713021Medicare PIN
ND14549Medicaid
MN080014611Medicare ID - Type Unspecified