Healthcare Provider Details

I. General information

NPI: 1154317469
Provider Name (Legal Business Name): MICHAEL D ROKAW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 BUCKNER ST STE C120
SHREVEPORT LA
71101-4440
US

IV. Provider business mailing address

1800 BUCKNER ST STE C120
SHREVEPORT LA
71101-4440
US

V. Phone/Fax

Practice location:
  • Phone: 318-227-8899
  • Fax: 318-222-0407
Mailing address:
  • Phone: 318-227-8899
  • Fax: 318-222-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number13152R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: