MEDICARE: DR. KEVIN TIMOTHY HAAG DPM

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	213E00000X	Podiatrist	5901002704	MI
2	213E00000X	Podiatrist	877	TN

General Provider Information

NPI Number	:	1174044010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN TIMOTHY HAAG DPM

Provider Business Mailing Address
First Line	:	4957 SWINYAR DR STE 105
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-2205
Country	:	US
Telephone Number	:	423-396-3668
Fax Number	:	423-396-2436

Provider Business Practice Location Address
First Line	:	9325 APISON PIKE STE 137
Second Line	:
City	:	COLLEGE DALE
State	:	TN
Zip	:	37363-3805
Country	:	US
Telephone Number	:	423-396-3668
Fax Number	:	423-396-2436

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

Provider Enumeration Date	:	06/30/2017
Last Update Date	:	09/03/2020

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