Provider Demographics
NPI:1023247582
Name:MICHAEL S HANEMANN JR MD LLC
Entity type:Organization
Organization Name:MICHAEL S HANEMANN JR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:HANEMANN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:504-460-3821
Mailing Address - Street 1:5233 DIJON DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4692
Mailing Address - Country:US
Mailing Address - Phone:225-766-2166
Mailing Address - Fax:225-766-2164
Practice Address - Street 1:5233 DIJON DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4692
Practice Address - Country:US
Practice Address - Phone:225-766-2166
Practice Address - Fax:225-766-2164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025571261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty