Provider Demographics
NPI:1851357032
Name:HAASE, GREGORY NORMAN (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:NORMAN
Last Name:HAASE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 996
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46581-0996
Mailing Address - Country:US
Mailing Address - Phone:574-372-5868
Mailing Address - Fax:574-372-5869
Practice Address - Street 1:1540 PROVIDENT DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3291
Practice Address - Country:US
Practice Address - Phone:574-372-5868
Practice Address - Fax:574-372-5869
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000857A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100158930Medicaid
187170HMedicare PIN
C25032Medicare UPIN
453220AAMedicare PIN
IN262490DMedicare PIN
INC25032Medicare UPIN