MEDICARE: DR. HALEY L P OWEN MD

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	207L00000X	Anesthesiology Physician	1733-850	WI

General Provider Information

NPI Number	:	1093886145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HALEY L P OWEN MD

Provider Business Mailing Address
First Line	:	6043 N BERKELEY BLVD
Second Line	:
City	:	WHITEFISH BAY
State	:	WI
Zip	:	53217-4643
Country	:	US
Telephone Number	:	414-507-8844
Fax Number	:

Provider Business Practice Location Address
First Line	:	6043 N BERKELEY BLVD
Second Line	:
City	:	WHITEFISH BAY
State	:	WI
Zip	:	53217-4643
Country	:	US
Telephone Number	:	414-507-8844
Fax Number	:

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

Provider Enumeration Date	:	11/12/2006
Last Update Date	:	11/22/2021

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