Provider Demographics
NPI:1083621759
Name:HAYWARD, MICHAEL T SR (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:HAYWARD
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:130 DESIARD ST
Mailing Address - Street 2:SUITE 355
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7319
Mailing Address - Country:US
Mailing Address - Phone:318-807-7875
Mailing Address - Fax:318-812-6603
Practice Address - Street 1:3400 MEDICAL PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2388
Practice Address - Country:US
Practice Address - Phone:318-387-6803
Practice Address - Fax:318-387-6874
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2019-06-12
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Provider Licenses
StateLicense IDTaxonomies
LAMD017690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1348619Medicaid
LA50663DD24Medicare PIN
LA1348619Medicaid