Healthcare Provider Details

I. General information

NPI: 1629001490
Provider Name (Legal Business Name): CHAD N HEINEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 SAINT JOSEPH AVE
LAKE CHARLES LA
70601-5006
US

IV. Provider business mailing address

2027 SAINT JOSEPH AVE
LAKE CHARLES LA
70601-5006
US

V. Phone/Fax

Practice location:
  • Phone: 337-515-0027
  • Fax: 888-336-6084
Mailing address:
  • Phone: 337-515-0027
  • Fax: 888-336-6084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-3962
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-023108
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: