Provider Demographics
NPI:1033148382
Name:HAIKEN, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HAIKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6017 COCOS DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4618
Mailing Address - Country:US
Mailing Address - Phone:239-691-3987
Mailing Address - Fax:
Practice Address - Street 1:8841 CODY LEE RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4500
Practice Address - Country:US
Practice Address - Phone:239-768-1400
Practice Address - Fax:239-768-5736
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL49016207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34059Medicare ID - Type Unspecified
FLD54292Medicare UPIN