Provider Demographics
NPI:1023053659
Name:HAEG, BENEDICT R (MD)
Entity type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:R
Last Name:HAEG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:425 ELM ST N
Mailing Address - Street 2:CENTRACARE HEALTH SYSTEM - SAUK CENTRE
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1010
Mailing Address - Country:US
Mailing Address - Phone:320-352-6591
Mailing Address - Fax:320-352-5164
Practice Address - Street 1:425 ELM ST N
Practice Address - Street 2:CENTRACARE HEALTH SYSTEM-SAUK CENTRE
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56303-1010
Practice Address - Country:US
Practice Address - Phone:320-352-6591
Practice Address - Fax:320-352-5164
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2015-04-06
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Provider Licenses
StateLicense IDTaxonomies
MN43659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA080184780OtherRAILROAD MEDICARE
MNN003453OtherCHAMPUS
MN52D34HAOtherBCBS
MN273673000Medicaid
MN52D34HAMedicare PIN
MNH45992Medicare UPIN
GA080184780OtherRAILROAD MEDICARE