Provider Demographics
NPI:1760441703
Name:HAAKE, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:HAAKE
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 1:200 QUEENS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3252
Mailing Address - Country:US
Mailing Address - Phone:704-333-7376
Mailing Address - Fax:704-333-3397
Practice Address - Street 1:1021 MOREHEAD MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2839
Practice Address - Country:US
Practice Address - Phone:704-355-2272
Practice Address - Fax:704-355-1865
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC310252085R0001X
SC147292085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2086252OtherUNITED HEALTHCARE
SCN31025Medicaid
NC62132OtherMEDCOST
NC8937998Medicaid
NC26022OtherPARTNERS
NC37998OtherBLUE CROSS
NC2021929009OtherCIGNA
NC62132OtherMEDCOST
NC37998OtherBLUE CROSS
NC2141206CMedicare ID - Type UnspecifiedUNIVERSITY RAD ONC CTR
NC2141206Medicare ID - Type Unspecified
NC26022OtherPARTNERS
NC2141206AMedicare ID - Type UnspecifiedMATTHEWS RAD ONC CTR
SCN31025Medicaid