Provider Demographics
NPI:1952483067
Name:HAUPT, PAUL A (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:HAUPT
Suffix:
Gender:M
Credentials:DO
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:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:920-445-7229
Practice Address - Street 1:106 S SCHOOL RD
Practice Address - Street 2:
Practice Address - City:DAGGETT
Practice Address - State:MI
Practice Address - Zip Code:49821-8555
Practice Address - Country:US
Practice Address - Phone:906-753-2155
Practice Address - Fax:906-753-2716
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB43579Medicare UPIN
WI000040160Medicare Oscar/Certification
MION412000020Medicare Oscar/Certification
WIK400189444Medicare Oscar/Certification