Healthcare Provider Details

I. General information

NPI: 1932195518
Provider Name (Legal Business Name): KIM MICHAEL SCHOEFFEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CURTISS RD 2 MDG SUITE 100
BARKSDALE AFB LA
71110-2425
US

IV. Provider business mailing address

134 DOWNING CT
BOSSIER CITY LA
71111-2243
US

V. Phone/Fax

Practice location:
  • Phone: 318-456-6358
  • Fax: 318-456-6938
Mailing address:
  • Phone: 318-752-4504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS 4507L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: