MEDICARE: DR. KASSIE ANNA HAITZ 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	207N00000X	Dermatology Physician	278185-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316180995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KASSIE ANNA HAITZ M.D.

Provider Business Mailing Address
First Line	:	100 WHITE SPUCE BLVD.
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1507
Country	:	US
Telephone Number	:	585-272-0700
Fax Number	:	585-272-8340

Provider Business Practice Location Address
First Line	:	100 WHITE SPRUCE BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1507
Country	:	US
Telephone Number	:	585-272-0700
Fax Number	:	585-272-8340

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

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	03/10/2026

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