MEDICARE: DOLPH D HAEGE 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
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	036088001	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00250827	OTHER	IL	MEDICARE RAILROAD

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639167570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOLPH D HAEGE MD

Provider Business Mailing Address
First Line	:	PO BOX 144333
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-4333
Country	:	US
Telephone Number	:	407-422-9831
Fax Number	:	407-648-2065

Provider Business Practice Location Address
First Line	:	211 S 3RD ST
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-1915
Country	:	US
Telephone Number	:	618-234-2120
Fax Number	:	618-222-4630

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/01/2008

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Directions to “ DOLPH D HAEGE MD” Practice Location

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