Basic Information
| Provider Information | |||||||||
| NPI: | 1083643498 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAUGEN | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Practice Location | |||||||||
| Address1: | 3902 13TH AVE S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581033357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013646600 | ||||||||
| FaxNumber: | 7013646628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 08/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4721 | ND | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 25433 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | ND100030 | 01 | ND | LHS # | OTHER | 3T637HA | 01 | ND | MNBS # | OTHER | 644307900 | 05 | ND | MEDICAID | 63D98HA | 01 | ND | MNBS # | OTHER | 0106129 | 01 | ND | MEDICA # | OTHER | 14615 | 05 | ND | MEDICAID | 1735 | 01 | ND | NDBS # | OTHER | HP19503 | 01 | ND | HEALTHPARTNERS # | OTHER | 0118705 | 01 | ND | MEDICA # | OTHER | 06004HA | 01 | ND | MNBS # | OTHER | DA9011015641 | 01 | ND | PREFERRED ONE # | OTHER | 169317 | 01 | ND | UCARE # | OTHER | 63322HA | 01 | ND | MNBS # | OTHER | 6438 | 01 | MN | NDBS # | OTHER | 676596 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER |