Healthcare Provider Details

I. General information

NPI: 1336115575
Provider Name (Legal Business Name): ROBERT CARL HAAKENSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S 13TH ST
OLIVIA MN
56277-1225
US

IV. Provider business mailing address

308 S 13TH ST
OLIVIA MN
56277-1225
US

V. Phone/Fax

Practice location:
  • Phone: 320-523-5129
  • Fax:
Mailing address:
  • Phone: 320-523-5129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number18578
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: