Provider Demographics
NPI:1053529727
Name:HYMBAUGH, MICHAEL EDWARD (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
Last Name:HYMBAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 NORTH BLVD
Mailing Address - Street 2:STE 250
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4013
Mailing Address - Country:US
Mailing Address - Phone:318-487-0138
Mailing Address - Fax:318-487-0134
Practice Address - Street 1:4560 NORTH BLVD
Practice Address - Street 2:STE 101
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4043
Practice Address - Country:US
Practice Address - Phone:225-341-5901
Practice Address - Fax:225-341-5903
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.13268R207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1577278Medicaid
LAH43975Medicare UPIN
LA4A503Medicare PIN