Provider Demographics
NPI:1831398015
Name:HAAG, MICHAEL RALPH (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RALPH
Last Name:HAAG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 LIMESTONE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1258
Mailing Address - Country:US
Mailing Address - Phone:302-239-1022
Mailing Address - Fax:
Practice Address - Street 1:5311 LIMESTONE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1246
Practice Address - Country:US
Practice Address - Phone:302-234-3907
Practice Address - Fax:302-234-3927
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006160213E00000X
NJ25MD000292400213E00000X
DEE1-0000189213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
162850Medicare PIN