Healthcare Provider Details

I. General information

NPI: 1083136402
Provider Name (Legal Business Name): MARCOS NICOLAS HAIKALIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2347 FIFTH AVE
MCKEESPORT PA
15132-1126
US

IV. Provider business mailing address

2347 FIFTH AVE
MCKEESPORT PA
15132-1126
US

V. Phone/Fax

Practice location:
  • Phone: 412-673-5009
  • Fax:
Mailing address:
  • Phone: 412-673-5009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT213096
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: