Provider Demographics
NPI:1104123314
Name:HASELRIG, MICHAEL W (RTR, RVT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:HASELRIG
Suffix:
Gender:M
Credentials:RTR, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 JACK WHITE DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-7712
Mailing Address - Country:US
Mailing Address - Phone:704-996-4341
Mailing Address - Fax:866-936-2017
Practice Address - Street 1:1416 JACK WHITE DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-7712
Practice Address - Country:US
Practice Address - Phone:704-996-4341
Practice Address - Fax:866-936-2017
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
56129246XC2903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist