Provider Demographics
NPI:1659318129
Name:DZEDA, MICHAEL F (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:DZEDA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 ESSEN LN STE 200
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3543
Mailing Address - Country:US
Mailing Address - Phone:225-215-1281
Mailing Address - Fax:225-215-1380
Practice Address - Street 1:4950 ESSEN LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3738
Practice Address - Country:US
Practice Address - Phone:225-767-0847
Practice Address - Fax:225-767-1335
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00055952085R0001X
MDD00545952085R0001X
PAMD052967L2085R0001X
LAMD.0212312085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD233604900Medicaid
DE0000935301Medicaid
DE920004715OtherRAILROAD MEDICARE
MD047M835EMedicare PIN
G10383Medicare UPIN
DE920004715OtherRAILROAD MEDICARE