Healthcare Provider Details

I. General information

NPI: 1184627986
Provider Name (Legal Business Name): MICHAEL O FLEMING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 11/08/2006
Reactivation Date: 11/08/2006

III. Provider practice location address

8383 MILLICENT WAY
SHREVEPORT LA
71115-5207
US

IV. Provider business mailing address

PO BOX 5687
SHREVEPORT LA
71135-5687
US

V. Phone/Fax

Practice location:
  • Phone: 318-797-6661
  • Fax: 318-795-8512
Mailing address:
  • Phone: 318-797-6661
  • Fax: 318-795-8512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13308
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: