Basic Information
| Provider Information | |||||||||
| NPI: | 1922084284 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAUG | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 512 SKYLINE BLVD | ||||||||
| Address2: | |||||||||
| City: | CLOQUET | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557201199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2188794641 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 512 SKYLINE BLVD | ||||||||
| Address2: | |||||||||
| City: | CLOQUET | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557201199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2188794641 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 46850-020 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 42654 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 5007 | AK | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | 10756 | MT | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | 10460 | ND | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0147339 | 05 | MT | MEDICAID |