Provider Demographics
NPI:1912906751
Name:HAASE, KRIS A (DPM)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:A
Last Name:HAASE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7116 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1503
Mailing Address - Country:US
Mailing Address - Phone:248-666-8807
Mailing Address - Fax:248-666-7709
Practice Address - Street 1:7116 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1503
Practice Address - Country:US
Practice Address - Phone:248-666-8807
Practice Address - Fax:248-666-7709
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKH001672213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7599462OtherAETNA
MIC8124OtherM CARE
MIKH001672OtherMICHIGAN LICENSE
MI480033238OtherRAILROAD MEDICARE
MI4856359200OtherBLUE CROSS AND BLUE SHIEL
MIKH001672OtherMICHIGAN LICENSE
MI7599462OtherAETNA
MIC8124OtherM CARE