Provider Demographics
NPI:1801423660
Name:HAEGGSTROEM, MIKAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MIKAEL
Middle Name:
Last Name:HAEGGSTROEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MIKAEL
Other - Middle Name:
Other - Last Name:HAGGSTROM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1445 FAIRLAWN WAY
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3563
Mailing Address - Country:US
Mailing Address - Phone:612-360-3910
Mailing Address - Fax:
Practice Address - Street 1:24 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6077
Practice Address - Country:US
Practice Address - Phone:203-739-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program