Provider Demographics
NPI:1134178239
Name:LAHAYE, PAUL ALAN (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ALAN
Last Name:LAHAYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-8364
Mailing Address - Fax:
Practice Address - Street 1:580 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2705
Practice Address - Country:US
Practice Address - Phone:906-225-4575
Practice Address - Fax:906-225-4578
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC40718207T00000X
MN69542207T00000X
MI4301091497207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1405211321OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
CAGR0030300Medicaid
A37434Medicare UPIN
CAGR0030300Medicaid
MI1405211321OtherBLUE CROSS BLUE SHIELD OF MICHIGAN