Basic Information
| Provider Information | |||||||||
| NPI: | 1780617571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAEUSSLEIN | ||||||||
| FirstName: | ERNEST | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 N IH 35 | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787011926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123248300 | ||||||||
| FaxNumber: | 5123248301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 W 38TH ST | ||||||||
| Address2: | SUITE 514 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126810500 | ||||||||
| FaxNumber: | 5126810501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 12/12/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | P1317 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 294032202 | 05 | TX | MEDICAID | 8DD094 | 01 | TX | BCBS | OTHER | 294032203 | 05 | TX | MEDICAID | 294032204 | 05 | TX | MEDICAID | 294032201 | 05 | TX | MEDICAID | 8ET246 | 01 | TX | BCBS | OTHER |