Provider Demographics
NPI:1669412995
Name:HAENEL, LOUIS CHARLES IV (DO)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:CHARLES
Last Name:HAENEL
Suffix:IV
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:888-472-0043
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:2093 HENRY TECKLENBURG DR STE 300E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5743
Practice Address - Country:US
Practice Address - Phone:843-724-2011
Practice Address - Fax:843-724-2034
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC472207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5616786OtherAETNA
SC004729Medicaid
PA000731432OtherHIGHMARK BLUE SHIELD
NJ0482818000OtherAMERIHEALTH HMO
NJ025194Medicare ID - Type Unspecified