MEDICARE: DR. GAIL SHARON HAIKEN 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	2080N0001X	Neonatal-Perinatal Medicine Physician	027582	CT

General Provider Information

NPI Number	:	1043767841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAIL SHARON HAIKEN M.D.

Provider Business Mailing Address
First Line	:	5303 REGENTS PARK RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5092
Country	:	US
Telephone Number	:	815-397-2528
Fax Number	:

Provider Business Practice Location Address
First Line	:	5303 REGENTS PARK RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5092
Country	:	US
Telephone Number	:	815-397-2528
Fax Number	:

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

Provider Enumeration Date	:	09/08/2016
Last Update Date	:	09/08/2016

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