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General NPI Number Information
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NPI Number | 1063474948
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Entity Type | Individual
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Provider Name | DAVID ANDREW HAGGSTROM M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | ROUDEBUSH VA MEDICAL CENTER 1481 WEST 10TH ST (11H)
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City | INDIANAPOLIS
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State | IN
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Zip | 46202
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Country | US
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Telephone | 317-988-2067
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Fax |
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Provider Business Mailing Address
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Address Line | 5406 N DELAWARE ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-3014
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Country | US
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Telephone | 317-664-5429
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A78268
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License Number State | CA
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