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General NPI Number Information
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NPI Number | 1366460917
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Entity Type | Individual
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Provider Name | PHILIP HARDWICK HALEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 8290 UNIVERSITY AVE NE SUITE 200
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City | FRIDLEY
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State | MN
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Zip | 55432-1847
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Country | US
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Telephone | 763-786-9543
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Fax | 763-786-3320
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Provider Business Mailing Address
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Address Line | 1017 W RIVER PKWY
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City | CHAMPLIN
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State | MN
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Zip | 55316-1039
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Country | US
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Telephone | 763-421-3088
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Fax | 763-421-3088
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 19477
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License Number State | MN
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