Individual
DOLPH D HAEGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
211 S 3RD ST, BELLEVILLE, IL 62220-1915
(618) 234-2120
(618) 222-4630
Mailing address
PO BOX 144333, ORLANDO, FL 32814-4333
(407) 422-9831
(407) 648-2065
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036088001
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360880012
—
IL
05
—
208789008
—
MO
01
—
P00250827
MEDICARE RAILROAD
IL
Enumeration date
10/13/2005
Last updated
07/01/2008
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