Basic Information
| Provider Information | |||||||||
| NPI: | 1275974255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAHUS | ||||||||
| FirstName: | KRYSTLE | ||||||||
| MiddleName: | SUSAN | ||||||||
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| Credential: | M.D. | ||||||||
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| OtherLastName: | HAAG | ||||||||
| OtherFirstName: | KRYSTLE | ||||||||
| OtherMiddleName: | S | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1028 | ||||||||
| Address2: | |||||||||
| City: | JASPER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475471028 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 721 W 13TH ST | ||||||||
| Address2: | SUITE 321 | ||||||||
| City: | JASPER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475461855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129967918 | ||||||||
| FaxNumber: | 8129961644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2013 | ||||||||
| LastUpdateDate: | 06/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 125.062982 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 01076569A | IN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.