Provider Demographics
NPI:1770505091
Name:HAAG, DAVID E (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:HAAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:765-298-5280
Mailing Address - Fax:765-724-3386
Practice Address - Street 1:2116 S PARK AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:IN
Practice Address - Zip Code:46001-8048
Practice Address - Country:US
Practice Address - Phone:765-724-4455
Practice Address - Fax:765-724-3386
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01027064A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200038550Medicaid
INP00099407OtherRR MEDICARE
IN000000312981OtherANTHEM
IN200038550Medicaid
INC03383Medicare UPIN
IN000000312981OtherANTHEM