MEDICARE: MAGDOUCHE MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	MD.204550	LA

General Provider Information

NPI Number	:	1942632633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGDOUCHE MEDICAL LLC

Provider Business Mailing Address
First Line	:	2739 STONE CREEK DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-8432
Country	:	US
Telephone Number	:	318-797-1743
Fax Number	:	318-797-7599

Provider Business Practice Location Address
First Line	:	2739 STONE CREEK DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-8432
Country	:	US
Telephone Number	:	318-797-1743
Fax Number	:	318-797-7599

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	JIHAD M EL HAYEK
Credential	:	M.D.
Telephone Number	:	214-405-2313

Provider Enumeration Date	:	08/05/2013
Last Update Date	:	08/12/2020

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Directions to “MAGDOUCHE MEDICAL LLC ” Practice Location

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