Provider Demographics
NPI:1831405208
Name:MICHAEL HAYWARD M.D. A MEDICAL CORPORATION
Entity type:Organization
Organization Name:MICHAEL HAYWARD M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-387-4855
Mailing Address - Street 1:3510 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2384
Mailing Address - Country:US
Mailing Address - Phone:318-387-4855
Mailing Address - Fax:318-325-2036
Practice Address - Street 1:3510 MEDICAL PARK DR
Practice Address - Street 2:SUITE 5
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2384
Practice Address - Country:US
Practice Address - Phone:318-387-4855
Practice Address - Fax:318-325-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.017690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1348619Medicaid
LA50663Medicare PIN
LAB62543Medicare UPIN