Individual
DR. HAEWON PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
601 W 2ND ST, BLOOMINGTON, IN 47403-2317
(812) 353-6821
Mailing address
PO BOX 4777, BLOOMINGTON, IN 47402-4777
(812) 336-1690
(812) 349-1311
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01053754A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01053754A
IN LICENSE
IN
01
—
01053754B
CSR
IN
05
—
200332500
—
IN
Enumeration date
08/31/2006
Last updated
03/07/2023
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