Lance Fay Haseltine, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

35039-20 Issued in WI

Practice address

24521 Poquette Lake Rd
Shell Lake, WI 54871-9240

Phone

(612) 991-4889

Fax

(715) 569-8698

NPI assigned

Jan 22, 2011

Last updated

Mar 4, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1295654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741046400000",
    "number": "1093010001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24521 POQUETTE LAKE RD",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "548719240",
            "telephone_number": "612-991-4889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24521 POQUETTE LAKE RD",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "548719240",
            "telephone_number": "612-991-4889",
            "fax_number": "715-569-8698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASELTINE",
        "first_name": "LANCE",
        "middle_name": "FAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-01-22",
        "last_updated": "2025-03-04",
        "certification_date": "2025-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MN",
            "license": "33541",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WI",
            "license": "35039-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Shell Lake, WI
• Providers in Shell Lake, WI by specialty
• General Practice Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.