MEDICARE: DR. MICHAEL R. 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	2085R0001X	Radiation Oncology Physician	31025	NC
2	2085R0001X	Radiation Oncology Physician	14729	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2086252	OTHER	NC	UNITED HEALTHCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	62132	OTHER	NC	MEDCOST
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	26022	OTHER	NC	PARTNERS
6	37998	OTHER	NC	BLUE CROSS
7	2021929009	OTHER	NC	CIGNA

General Provider Information

NPI Number	:	1760441703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL R. HAAKE M.D.

Provider Business Mailing Address
First Line	:	200 QUEENS RD
Second Line	:	SUITE 400
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3252
Country	:	US
Telephone Number	:	704-333-7376
Fax Number	:	704-333-3397

Provider Business Practice Location Address
First Line	:	1021 MOREHEAD MEDICAL DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2839
Country	:	US
Telephone Number	:	704-355-2272
Fax Number	:	704-355-1865

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	12/19/2012

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Directions to “ DR. MICHAEL R. HAAKE M.D.” Practice Location

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