Provider Demographics
NPI:1508265638
Name:MICHAEL S HAYDEL MD APMC
Entity Type:Organization
Organization Name:MICHAEL S HAYDEL MD APMC
Other - Org Name:HAYDEL SPINE & PAIN SPECIALTY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAYDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-223-3132
Mailing Address - Street 1:PO BOX 1094
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-1094
Mailing Address - Country:US
Mailing Address - Phone:985-223-3132
Mailing Address - Fax:985-223-3126
Practice Address - Street 1:1103 KALISTE SALOOM RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5783
Practice Address - Country:US
Practice Address - Phone:337-233-2504
Practice Address - Fax:985-223-3126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL S HAYDEL MD APMC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.021195207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAE68184Medicare UPIN
LA5N379Medicare PIN