Healthcare Provider Details

I. General information

NPI: 1093070476
Provider Name (Legal Business Name): MICHAEL F HORAIST, M.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 W UNIVERSITY AVE
LAFAYETTE LA
70506-3462
US

IV. Provider business mailing address

1103 W UNIVERSITY AVE
LAFAYETTE LA
70506-3462
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-0219
  • Fax: 337-233-2418
Mailing address:
  • Phone: 337-233-0219
  • Fax: 337-233-2418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number203145
License Number StateLA

VIII. Authorized Official

Name: DR. MICHAEL F HORAIST
Title or Position: PRESIDENT
Credential: M.D.
Phone: 337-233-0219