Basic Information
| Provider Information | |||||||||
| NPI: | 1881218600 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENNIG | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 MARIE ANTOINETTE ST APT 142 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705066206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854696088 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2390 W CONGRESS ST | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705064205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372616000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2020 | ||||||||
| LastUpdateDate: | 09/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 125.076782 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 332372 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.