Healthcare Provider Details

I. General information

NPI: 1316987381
Provider Name (Legal Business Name): RICHARD A HAAS MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 W LIEBAU ROAD SUITE 104
MEQUON WI
53092-3333
US

IV. Provider business mailing address

4555 WEST SCHROEDER DRIVE SUITE 170
MILWAUKEE WI
53223
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-1244
  • Fax: 262-243-1251
Mailing address:
  • Phone: 414-365-3210
  • Fax: 414-365-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number21702020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number21702020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: