Healthcare Provider Details

I. General information

NPI: 1962600346
Provider Name (Legal Business Name): MICHAEL M HALEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 EXCELSIOR BLVD
ST LOUIS PARK MN
55426-4702
US

IV. Provider business mailing address

7401 METRO BLVD STE 210
EDINA MN
55439-3086
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-6032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number54122
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: