Healthcare Provider Details

I. General information

NPI: 1659318129
Provider Name (Legal Business Name): MICHAEL F DZEDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 ESSEN LN
BATON ROUGE LA
70809-3738
US

IV. Provider business mailing address

5215 ESSEN LN STE 200
BATON ROUGE LA
70809-3543
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-0847
  • Fax: 225-767-1335
Mailing address:
  • Phone: 225-215-1281
  • Fax: 225-215-1380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberC1-0005595
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberD0054595
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD052967L
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD.021231
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: