Healthcare Provider Details

I. General information

NPI: 1184624686
Provider Name (Legal Business Name): MICHAEL HENRY GOOSZEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1453 E BERT KOUN LOOP SUITE 112
SHREVEPORT LA
71105-6800
US

IV. Provider business mailing address

PO BOX 51008
SHREVEPORT LA
71135-1008
US

V. Phone/Fax

Practice location:
  • Phone: 318-798-9400
  • Fax: 318-424-0717
Mailing address:
  • Phone: 318-798-9400
  • Fax: 318-213-7276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number08865R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: