Basic Information
| Provider Information | |||||||||
| NPI: | 1770665655 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAIG | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 373 BLAIR PARK RD UNIT 206 | ||||||||
| Address2: | |||||||||
| City: | WILLISTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054958056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028575671 | ||||||||
| FaxNumber: | 8026624835 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 EAST EISENHOWER PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481083364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349367175 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 10/25/2018 | ||||||||
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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 | 208100000X | 4301067189 | MI | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2081P2900X | 3056920 | WI | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 2081P2900X | 4301067189 | MI | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 2081P2900X | 420007461 | VT | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3253994 | 05 | MI | MEDICAID | 1031007 | 05 | VT | MEDICAID | 05005183 | 05 | NY | MEDICAID |