Healthcare Provider Details

I. General information

NPI: 1760682272
Provider Name (Legal Business Name): MICHEL E. HEARD, M.D. (A MEDICAL CORPORATION)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 SAINT THOMAS ST SUITE A
LAFAYETTE LA
70506-4575
US

IV. Provider business mailing address

3607 OLD CONEJO RD
THOUSAND OAKS CA
91320-2123
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-0898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberBH2497293
License Number StateLA

VIII. Authorized Official

Name: DR. MICHEL E HEARD
Title or Position: PHYSICIAN
Credential:
Phone: 337-234-0898