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NPI Code Detail

MEDICARE: KRISTOPH MICHAEL HAAK MD

MEDICARE: KRISTOPH MICHAEL HAAK MD
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207P00000XEmergency Medicine PhysicianDR.0061788CO

General Provider Information

NPI Number : 1053739573
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTOPH MICHAEL HAAK MD
Provider Business Mailing Address
First Line : 400 W 16TH ST
Second Line :
City : PUEBLO
State : CO
Zip : 81003-2781
Country : US
Telephone Number : 719-584-4306
Fax Number : 719-595-7886
Provider Business Practice Location Address
First Line : 400 W 16TH ST
Second Line :
City : PUEBLO
State : CO
Zip : 81003-2781
Country : US
Telephone Number : 719-584-4306
Fax Number : 719-595-7886
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2014
Last Update Date : 07/18/2019

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