Provider Demographics
NPI:1922064237
Name:HALEY, MICHAEL DENNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DENNIS
Last Name:HALEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N KIMBALL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-1113
Mailing Address - Country:US
Mailing Address - Phone:605-996-8989
Mailing Address - Fax:605-996-6910
Practice Address - Street 1:2200 N KIMBALL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-1113
Practice Address - Country:US
Practice Address - Phone:605-996-8989
Practice Address - Fax:605-996-6910
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2109208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7300592Medicaid
SD7300592Medicaid
D25307Medicare UPIN