Provider Demographics
NPI:1265439863
Name:DURCI, MICHAEL LEONARD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEONARD
Last Name:DURCI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2600 KINGS HWY
Mailing Address - Street 2:WILLIS KNIGHTON CANCER CENTER
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3950
Mailing Address - Country:US
Mailing Address - Phone:318-212-4639
Mailing Address - Fax:318-212-8305
Practice Address - Street 1:2600 KINGS HWY
Practice Address - Street 2:WILLIS KNIGHTON CANCER CENTER
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3950
Practice Address - Country:US
Practice Address - Phone:318-212-4639
Practice Address - Fax:318-212-8305
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA08279R2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX053365501Medicaid
AR133510001Medicaid
LA1927911Medicaid
TX053365501Medicaid
AR133510001Medicaid
LA57520Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
LA300056078Medicare ID - Type UnspecifiedRAILROAD MEDICARE
5N890CK38Medicare ID - Type UnspecifiedWK GROUP MEDICARE