Healthcare Provider Details

I. General information

NPI: 1063441665
Provider Name (Legal Business Name): MICHAEL HAILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RUE DE LA VIE ST STE 201
BATON ROUGE LA
70817-5128
US

IV. Provider business mailing address

500 RUE DE LA VIE ST STE 201
BATON ROUGE LA
70817-5128
US

V. Phone/Fax

Practice location:
  • Phone: 225-216-1118
  • Fax: 225-216-1119
Mailing address:
  • Phone: 225-751-2778
  • Fax: 225-753-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number14794R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.14794R
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD.14794R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: