Basic Information
| Provider Information | |||||||||
| NPI: | 1245274927 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAUPT | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1357 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339021357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392783600 | ||||||||
| FaxNumber: | 2392783203 | ||||||||
| Practice Location | |||||||||
| Address1: | 708 DEL PRADO BLVD | ||||||||
| Address2: | SUITE 9 | ||||||||
| City: | CAPE CORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339905616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395742644 | ||||||||
| FaxNumber: | 2395741451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2009 | ||||||||
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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 | 207P00000X | ME49906 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208D00000X | ME49906 | FL | N | Allopathic & Osteopathic Physicians | General Practice | 207R00000X | ME49906 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 231025 | 01 | FL | AMERIGROUP | OTHER | 04476X | 01 | FL | MEDICARE PTAN | OTHER | 046057500 | 05 | FL | MEDICAID | 2567719 | 01 | FL | CIGNA | OTHER | 930074798 | 01 | FL | RAILROAD | OTHER | 4235619 | 01 | FL | AETNA | OTHER | 04467 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |