Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301062290 | MI |
N | 111NI0900X | Internist | 4301062290 | MI |
Y | 207RC0000X | Internist - Cardiovascular Disease | 4301062290 | MI |
NPI | 1023058575 |
---|---|
Provider Name | Dr. Luis C Afonso |
First Address | Troy, MI 48083-1138 |
Second Address | Detroit, MI 48201-2014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 15/01/2016 |