# HIGHLAND CLINIC, A PROF MED CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740897743
- **Authorized official:** MR. MICHAEL GUSTAVSON (ADMINISTRATOR)
- **Authorized official phone:** (318) 798-4465

## Contact information

- **Practice address:** 5025 SHED RD, BOSSIER CITY, LA 71111-5434
- **Practice address phone:** (318) 795-4741
- **Practice address fax:** (318) 795-4742
- **Mailing address:** 1455 E BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71105-5634
- **Mailing address phone:** (318) 798-4500
- **Mailing address fax:** (318) 798-4601

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/24/2020
- **Last updated:** 06/02/2026