Healthcare Provider Details

I. General information

NPI: 1275974255
Provider Name (Legal Business Name): KRYSTLE SUSAN HAHUS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRYSTLE S HAAG

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18485 STATE ROAD 37
LEOPOLD IN
47551-8072
US

IV. Provider business mailing address

8885 STATE ROAD 237
TELL CITY IN
47586-8567
US

V. Phone/Fax

Practice location:
  • Phone: 812-843-3038
  • Fax:
Mailing address:
  • Phone: 812-547-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.062982
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01076569A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: