Healthcare Provider Details

I. General information

NPI: 1922064237
Provider Name (Legal Business Name): MICHAEL DENNIS HALEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N KIMBALL ST SUITE 200
MITCHELL SD
57301-1113
US

IV. Provider business mailing address

2200 N KIMBALL ST SUITE 200
MITCHELL SD
57301-1113
US

V. Phone/Fax

Practice location:
  • Phone: 605-996-8989
  • Fax: 605-996-6910
Mailing address:
  • Phone: 605-996-8989
  • Fax: 605-996-6910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2109
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: