Provider Demographics
NPI:1689613903
Name:HAEGER, CARL RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:RICHARD
Last Name:HAEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19727 ALLEN RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1188
Mailing Address - Country:US
Mailing Address - Phone:734-479-8000
Mailing Address - Fax:734-479-4812
Practice Address - Street 1:19727 ALLEN RD
Practice Address - Street 2:SUITE 12
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1188
Practice Address - Country:US
Practice Address - Phone:734-479-8000
Practice Address - Fax:734-479-4812
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301028995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2950619-10Medicaid
MIB48160Medicare UPIN
MIOF37698Medicare ID - Type Unspecified