Basic Information
| Provider Information | |||||||||
| NPI: | 1205827466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAUGE | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2550 UNIVERSITY AVE W STE 110N | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551142001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516025309 | ||||||||
| FaxNumber: | 6512226786 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 W CHANDLER ST | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553072127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5079642271 | ||||||||
| FaxNumber: | 5079645898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 23544 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 110902 | 01 | U CARE | OTHER | 3600191 | 01 | MEDICA HEALTH PLANS | OTHER | 508R1HA | 01 | BLUE CROSS BLUE SHIELD | OTHER | 600901 | 01 | ARAZ GROUP AMERICAS PPO | OTHER | 110105132 | 01 | RR MEDICARE | OTHER | 6D067HA | 01 | BLUE CROSS BLUE SHIELD | OTHER | HP13485 | 01 | HEALTH PARTNERS | OTHER | 1000212 | 01 | PREFERRED ONE | OTHER | 2114005 | 01 | FIRST HEALTH PLAN | OTHER | 878098600 | 01 | MEDICAL ASSISTANCE | OTHER |