Healthcare Provider Details

I. General information

NPI: 1053999276
Provider Name (Legal Business Name): DANIELA ANDREA HAEHN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S PARK AVE
HERRIN IL
62948-3602
US

IV. Provider business mailing address

PO BOX 3988
CARBONDALE IL
62902-3988
US

V. Phone/Fax

Practice location:
  • Phone: 618-988-6240
  • Fax: 618-351-4814
Mailing address:
  • Phone: 618-457-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036180458
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME159185
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: