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NPI Code Detail

MEDICARE: IWONA M. PAKULA-HALLER M.D.

MEDICARE: IWONA M. PAKULA-HALLER 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
12084P0800XPsychiatry PhysicianIL

General Provider Information

NPI Number : 1154345809
Entity Type Code : Individual
Provider Name (Legal Business Name) : IWONA M. PAKULA-HALLER M.D.
Provider Business Mailing Address
First Line : 21425 SPRING ST
Second Line : PRIMARY CARE UNION GROVE
City : UNION GROVE
State : WI
Zip : 53182-9707
Country : US
Telephone Number : 262-878-7001
Fax Number : 262-878-7024
Provider Business Practice Location Address
First Line : 21425 SPRING ST
Second Line : PRIMARY CARE UNION GROVE
City : UNION GROVE
State : WI
Zip : 53182-9707
Country : US
Telephone Number : 262-878-7001
Fax Number : 262-878-7024
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 07/08/2007

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