Provider Demographics
NPI:1629003793
Name:HAIK, CHRIS G (NP)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:G
Last Name:HAIK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:2647 S SAINT ELIZABETH BLVD STE 125
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5020
Practice Address - Country:US
Practice Address - Phone:225-647-9675
Practice Address - Fax:225-647-9676
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN099206363LA2200X
LAAP04892363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1077062Medicaid
LA1077062Medicaid
LA4H896CQ60Medicare PIN
LAQ70639Medicare UPIN