Provider Demographics
NPI:1932466216
Name:VAN VLIET, HALEH (MD)
Entity Type:Individual
Prefix:DR
First Name:HALEH
Middle Name:
Last Name:VAN VLIET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HALEH
Other - Middle Name:
Other - Last Name:KADIVAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1600 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-5008
Mailing Address - Country:US
Mailing Address - Phone:610-327-7744
Mailing Address - Fax:
Practice Address - Street 1:5162 ANTON DR
Practice Address - Street 2:APT 301
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-1777
Practice Address - Country:US
Practice Address - Phone:423-316-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD469738207P00000X
WI62233207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine