Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 28714 | AL |
Y | 208200000X | Surgeon | MD.025571 | LA |
Y | 208600000X | Surgeon | MD.025571 | LA |
NPI | 1457573065 |
---|---|
Provider Name | Dr. Michael Stephen Hanemann JR. |
First Address | Baton Rouge, LA 70808-4692 |
Second Address | Baton Rouge, LA 70808-4692 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 23/07/2014 |