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Individual

DR. TRACY ANN HAERTLING

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
615 N MICHIGAN ST, 6 EAST, SOUTH BEND, IN 46601-1033
(574) 647-6892
(574) 647-6895
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610

Taxonomy

Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
02004056A
IN
2080P0207X
Pediatric Hematology & Oncology Physician
036123303
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000781399
BCBS MEMORIAL CHILDRENS HOSPITAL
IN
05
201085280
IN
Enumeration date
07/31/2007
Last updated
03/16/2016
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