MEDICARE: DR. MICHAEL LARSON HAUGSDAL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	R-9698	IA

General Provider Information

NPI Number	:	1073951059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL LARSON HAUGSDAL M.D.

Provider Business Mailing Address
First Line	:	200 HAWKINS DR
Second Line	:	UIHC, DEPT OF OB/GYN
City	:	IOWA CITY
State	:	IA
Zip	:	52241-1009
Country	:	US
Telephone Number	:	319-356-2294
Fax Number	:	319-356-7533

Provider Business Practice Location Address
First Line	:	200 HAWKINS DR.
Second Line	:	UIHC, DEPT OF OB/GYN
City	:	IOWA CITY
State	:	IA
Zip	:	52241-1009
Country	:	US
Telephone Number	:	319-356-2294
Fax Number	:	319-356-7533

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2013
Last Update Date	:	04/18/2017

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