Healthcare Provider Details

I. General information

NPI: 1770665655
Provider Name (Legal Business Name): ANDREW J HAIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 EAST EISENHOWER PKWY SUITE 100
ANN ARBOR MI
48108-3364
US

IV. Provider business mailing address

373 BLAIR PARK RD UNIT 206
WILLISTON VT
05495-8056
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-7175
  • Fax:
Mailing address:
  • Phone: 802-857-5671
  • Fax: 802-662-4835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301067189
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number3056920
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number4301067189
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number420007461
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: