Individual
DR. DEGAULLE G. HAILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2114 25TH ST STE A, COLUMBUS, IN 47201-3239
(812) 372-1581
(812) 376-4028
Mailing address
PO BOX 775383, CHICAGO, IL 60677-5383
(812) 376-5315
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
036110330
IL
207V00000X
Obstetrics & Gynecology Physician
Primary
01072506A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000984538
ANTHEM PIN
IN
05
—
036110330
—
IL
05
—
201176670
—
IN
Enumeration date
10/10/2006
Last updated
02/19/2024
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