Basic Information
Provider Information
NPI: 1467567685
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAIME
FirstName: MIGUEL
MiddleName: EMILIO
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 850 HARRISON AVE
Address2: YACC-BNC7
City: BOSTON
State: MA
PostalCode: 021184001
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 732 HARRISON AVE
Address2: 3RD FLOOR
City: BOSTON
State: MA
PostalCode: 021182309
CountryCode: US
TelephoneNumber: 6176385600
FaxNumber: 6176387228
Other Information
ProviderEnumerationDate: 08/20/2006
LastUpdateDate: 11/06/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208G00000X203095MAY Allopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery) 

ID Information
IDTypeStateIssuerDescription
110003814A05MA MEDICAID


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