Provider Demographics
NPI:1912219254
Name:HA, MICHELLE W (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:W
Last Name:HA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2160 S. FIRST AVENUE RM 7609
Mailing Address - Street 2:LOYOLA UNIVERSITY MEDICAL CENTER LUH- NORTH ENTRANCE
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-6497
Mailing Address - Fax:
Practice Address - Street 1:2160 S. FIRST AVENUE RM 7609
Practice Address - Street 2:LOYOLA UNIVERSITY MEDICAL CENTER LUH- NORTH ENTRANCE
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-6497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125.058138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine