Basic Information
| Provider Information | |||||||||
| NPI: | 1265439863 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURCI | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | LEONARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 KINGS HWY | ||||||||
| Address2: | WILLIS KNIGHTON CANCER CENTER | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711033950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182124639 | ||||||||
| FaxNumber: | 3182128305 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 KINGS HWY | ||||||||
| Address2: | WILLIS KNIGHTON CANCER CENTER | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711033950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182124639 | ||||||||
| FaxNumber: | 3182128305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2005 | ||||||||
| LastUpdateDate: | 06/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 08279R | LA | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 053365501 | 05 | TX | MEDICAID | 133510001 | 05 | AR | MEDICAID | 1927911 | 05 | LA | MEDICAID |