Healthcare Provider Details

I. General information

NPI: 1821676230
Provider Name (Legal Business Name): JUSTIN MATTHEW HULIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 W CONGRESS ST
LAFAYETTE LA
70506-4205
US

IV. Provider business mailing address

140 E LAKE CT
SLIDELL LA
70461-5613
US

V. Phone/Fax

Practice location:
  • Phone: 337-261-6166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number343234
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: