Provider Demographics
NPI:1669902649
Name:HAACK, KIRSTEN JENNIFER (MD)
Entity type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:JENNIFER
Last Name:HAACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIRSTEN
Other - Middle Name:HAACK
Other - Last Name:HAMEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1501
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:6431 FANNIN ST STE MSB 5196
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-6223
Practice Address - Fax:713-500-6270
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS9694207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program