Healthcare Provider Details

I. General information

NPI: 1801389580
Provider Name (Legal Business Name): MICHAEL HAUK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 FAIRFAX DR STE 31
ARLINGTON VA
22203-1762
US

IV. Provider business mailing address

3801 FAIRFAX DR STE 31
ARLINGTON VA
22203-1762
US

V. Phone/Fax

Practice location:
  • Phone: 571-229-5081
  • Fax:
Mailing address:
  • Phone: 571-229-5081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT216060
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number4351048005
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number0101277806
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: