Individual
GEORGE MYCHASKIW II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
(318) 629-4833
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
321616
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00112233
—
MS
01
—
050069240
RAILROAD MEDICARE
MS
01
—
P00622803
RAILROAD MEDICARE
MS
Enumeration date
09/28/2006
Last updated
09/11/2025
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