1861484669 NPI number — ROBERT E HASELOW MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861484669 NPI number — ROBERT E HASELOW MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HASELOW

Provider First Name:

ROBERT

Provider Middle Name:

E

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1861484669

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/05/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

7401 METRO BLVD STE 210

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

EDINA

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55439-3086

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

952-920-4915

Provider Business Mailing Address Fax Number:

952-915-6091

Provider First Line Business Practice Location Address:

6500 EXCELSIOR BLVD

Provider Second Line Business Practice Location Address:

METHODIST RADIATION THERAPY

Provider Business Practice Location Address City Name:

ST LOUIS PARK

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55426-4702

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

952-993-6032

Provider Business Practice Location Address Fax Number:

952-993-5512

Provider Enumeration Date:

08/17/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0001X , with the licence number:  21699 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 06667HA . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 25140 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 104841 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 110582 . This is a "CHOICE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 30624100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
• Identifier: 963070250001 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 085005500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 2400004 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 2402659 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: HP13510 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".