Healthcare Provider Details

I. General information

NPI: 1922218239
Provider Name (Legal Business Name): MICHAEL F HORAIST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BEAULLIEU DR BLDG 3B
LAFAYETTE LA
70508-7230
US

IV. Provider business mailing address

200 BEAULLIEU DR BLDG 3B
LAFAYETTE LA
70508-7230
US

V. Phone/Fax

Practice location:
  • Phone: 337-524-1414
  • Fax: 337-443-4457
Mailing address:
  • Phone: 337-524-1414
  • Fax: 337-443-4457

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 Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number203145
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: