MEDICARE: DR. KARL DEHAAN 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	207RG0100X	Gastroenterology Physician	AD6714732	OH

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	:	1982622338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARL DEHAAN MD

Provider Business Mailing Address
First Line	:	1 INFINITY CORPORATE CENTRE DR
Second Line	:	SUITE 130
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-5369
Country	:	US
Telephone Number	:	216-663-7064
Fax Number	:	216-663-8286

Provider Business Practice Location Address
First Line	:	1 INFINITY CORPORATE CENTRE DR
Second Line	:	SUITE 130
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-5369
Country	:	US
Telephone Number	:	216-663-7064
Fax Number	:	216-663-8286

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	04/20/2008

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