Healthcare Provider Details

I. General information

NPI: 1477555621
Provider Name (Legal Business Name): PAUL A HAIGHT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W SAVIDGE ST
SPRING LAKE MI
49456-1620
US

IV. Provider business mailing address

PO BOX 1848
MUSKEGON MI
49443-1848
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-3100
  • Fax: 231-672-3102
Mailing address:
  • Phone: 231-727-4444
  • Fax: 231-727-4451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101005914
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: