Individual
ANITA N HAGGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
550 UNIVERSITY BLVD, UH3240, INDIANAPOLIS, IN 46202-5149
(317) 274-7744
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
(317) 944-7744
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01062369A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200833310
—
IN
Enumeration date
08/30/2006
Last updated
04/10/2019
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