Provider Demographics
NPI:1396781357
Name:HAAG, BRIAN W (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:HAAG
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 1:6620 PARKDALE PL
Mailing Address - Street 2:SUITE N
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5620
Mailing Address - Country:US
Mailing Address - Phone:317-244-7160
Mailing Address - Fax:317-244-7166
Practice Address - Street 1:6620 PARKDALE PL
Practice Address - Street 2:SUITE N
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5620
Practice Address - Country:US
Practice Address - Phone:317-244-7160
Practice Address - Fax:317-244-7166
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028599A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
020010156OtherMEDICARE RAIL ROAD
IN100189930Medicaid
IN020039695OtherMEDICARE RAIL ROAD (IU HEALTH)
IN020039695OtherMEDICARE RAIL ROAD (IU HEALTH)
INP01163194Medicare PIN
020010156OtherMEDICARE RAIL ROAD
IN222050CMedicare ID - Type Unspecified