Provider Demographics
NPI:1740621309
Name:HAASTRUP, MICHEAL
Entity type:Individual
Prefix:MR
First Name:MICHEAL
Middle Name:
Last Name:HAASTRUP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 TAMARACK BLVD
Mailing Address - Street 2:APT 218
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6567
Mailing Address - Country:US
Mailing Address - Phone:347-972-9879
Mailing Address - Fax:
Practice Address - Street 1:4645 TAMARACK BLVD
Practice Address - Street 2:APT 218
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6567
Practice Address - Country:US
Practice Address - Phone:347-972-9879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance