Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 4301034441 | MI |
NPI | 1033224217 |
---|---|
Provider Name | Dr. Luis Gabriel Camero |
First Address | Saint Clair Shores, MI 48080-1181 |
Second Address | Saint Clair Shores, MI 48080-1181 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 25/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1575219 | (05) | MI |
3305000291 | BCBSM (01) | MI |
70101A | HEALTH ALLIANCE PLAN (01) | MI |
B44016 | (02) | MI |
P41778 | BLUE CARE NETWORK (01) | MI |