Provider Demographics
NPI:1821062415
Name:HAUGEN, ERIC N (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:N
Last Name:HAUGEN
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 1:101 WILLMAR AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201
Mailing Address - Country:US
Mailing Address - Phone:320-231-5000
Mailing Address - Fax:320-231-5067
Practice Address - Street 1:101 WILLMAR AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201
Practice Address - Country:US
Practice Address - Phone:320-231-5000
Practice Address - Fax:320-231-5067
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37379207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN428026100Medicaid
MN390000281Medicare ID - Type Unspecified
MN428026100Medicaid
MN110167102Medicare ID - Type UnspecifiedRAILROAD