Provider Demographics
NPI:1851340145
Name:HALLER, KURT A (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:A
Last Name:HALLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1052 GULL RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1734
Mailing Address - Country:US
Mailing Address - Phone:269-343-1684
Mailing Address - Fax:269-343-5375
Practice Address - Street 1:1052 GULL RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1734
Practice Address - Country:US
Practice Address - Phone:269-343-1684
Practice Address - Fax:269-343-5375
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301407101207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI135840000OtherDEPARTMENT OF LABOR
MI180035058OtherRAILROAD MEDICARE
MI180C911240OtherBCBSM
MI4302174OtherAETNA
MI0830591OtherIBA/PHP
MI119351OtherGREAT LAKES HEALTH PLAN
MI3373034Medicaid
MI3833092991335OtherCOMMUNITY CHOICE
MI383309299006OtherTRICARE
MI4302174OtherAETNA
MI3833092991335OtherCOMMUNITY CHOICE