Healthcare Provider Details

I. General information

NPI: 1205827466
Provider Name (Legal Business Name): MARK D HAUGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W CHANDLER ST
ARLINGTON MN
55307-2127
US

IV. Provider business mailing address

2550 UNIVERSITY AVE W STE 110N
SAINT PAUL MN
55114-2001
US

V. Phone/Fax

Practice location:
  • Phone: 507-964-2271
  • Fax: 507-964-5898
Mailing address:
  • Phone: 651-602-5309
  • Fax: 651-222-6786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number23544
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: