Healthcare Provider Details

I. General information

NPI: 1265439863
Provider Name (Legal Business Name): MICHAEL LEONARD DURCI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 KINGS HWY WILLIS KNIGHTON CANCER CENTER
SHREVEPORT LA
71103-3950
US

IV. Provider business mailing address

2600 KINGS HWY WILLIS KNIGHTON CANCER CENTER
SHREVEPORT LA
71103-3950
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-4639
  • Fax: 318-212-8305
Mailing address:
  • Phone: 318-212-4639
  • Fax: 318-212-8305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number08279R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: