MEDICARE: DR. BENEDICT R. HAEG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	43659	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080184780	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	N003453	OTHER	MN	CHAMPUS
3	52D34HA	OTHER	MN	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023053659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENEDICT R. HAEG M.D.

Provider Business Mailing Address
First Line	:	425 ELM ST N
Second Line	:	CENTRACARE HEALTH SYSTEM - SAUK CENTRE
City	:	SAUK CENTRE
State	:	MN
Zip	:	56303-1010
Country	:	US
Telephone Number	:	320-352-6591
Fax Number	:	320-352-5164

Provider Business Practice Location Address
First Line	:	425 ELM ST N
Second Line	:	CENTRACARE HEALTH SYSTEM-SAUK CENTRE
City	:	SAUK CENTRE
State	:	MN
Zip	:	56303-1010
Country	:	US
Telephone Number	:	320-352-6591
Fax Number	:	320-352-5164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	04/06/2015

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