Provider Demographics
NPI:1841233608
Name:TORMA, MICHAEL JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:TORMA
Suffix:
Gender:M
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:P.O. BOX 52569
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-2569
Mailing Address - Country:US
Mailing Address - Phone:318-212-5911
Mailing Address - Fax:318-212-5931
Practice Address - Street 1:2530 BERT KOUNS INDUSTRIAL BLVD.
Practice Address - Street 2:SUITE 138
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-6114
Practice Address - Country:US
Practice Address - Phone:318-212-5911
Practice Address - Fax:318-212-5931
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12523R2083P0011X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP0020170OtherRAILROAD MEDICARE
LAP00201070OtherRR MEDICARE
LA810643587OtherCHAMPUS / TRICARE
LA1159999Medicaid
LA810643587OtherCHAMPUS / TRICARE
LAP0020170OtherRAILROAD MEDICARE
LA1159999Medicaid