MEDICARE: DR. P WILLIAM HAAKE 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	174400000X	Specialist	097375-1	NY

General Provider Information

NPI Number	:	1659494698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. P WILLIAM HAAKE M.D.

Provider Business Mailing Address
First Line	:	712 QUAKER RD
Second Line	:
City	:	SCOTTSVILLE
State	:	NY
Zip	:	14546-9635
Country	:	US
Telephone Number	:	585-889-1958
Fax Number	:	585-889-1958

Provider Business Practice Location Address
First Line	:	712 QUAKER RD
Second Line	:
City	:	SCOTTSVILLE
State	:	NY
Zip	:	14546-9635
Country	:	US
Telephone Number	:	585-889-1958
Fax Number	:	585-889-1958

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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