Healthcare Provider Details

I. General information

NPI: 1922054220
Provider Name (Legal Business Name): KRIS A HAASE DPM PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7116 HIGHLAND RD
WATERFORD MI
48327-1503
US

IV. Provider business mailing address

7116 HIGHLAND RD
WATERFORD MI
48327-1503
US

V. Phone/Fax

Practice location:
  • Phone: 248-666-8807
  • Fax: 248-666-7709
Mailing address:
  • Phone: 248-666-8807
  • Fax: 248-666-7709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberKH001672
License Number StateMI

VIII. Authorized Official

Name: DR. KRIS A HAASE
Title or Position: OWNER
Credential: DPM
Phone: 248-666-8807