Organization
HIGHLAND CLINIC, A PROF MED CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL GUSTAVSON (ADMINISTRATOR)
(318) 798-4465
Entity
Organization
Contact information
Practice address
471 ASHLEY RIDGE BLVD, SHREVEPORT, LA 71106-7229
(318) 795-4770
(318) 795-4775
Mailing address
1455 E BERT KOUN LOOP, SHREVEPORT, LA 71105-5634
(318) 798-4500
(318) 798-4555
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1038300
—
LA
Enumeration date
10/22/2015
Last updated
06/02/2026
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