Provider Demographics
NPI:1922218239
Name:HORAIST, MICHAEL F (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:HORAIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BEAULLIEU DR
Mailing Address - Street 2:BLDG 3B
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7230
Mailing Address - Country:US
Mailing Address - Phone:337-524-1414
Mailing Address - Fax:337-443-4457
Practice Address - Street 1:200 BEAULLIEU DR
Practice Address - Street 2:BLDG 3B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7230
Practice Address - Country:US
Practice Address - Phone:337-524-1414
Practice Address - Fax:337-443-4457
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA203145208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA07928Medicaid