Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 5501005659 | OH |
Y | 213ES0000X | Sports Medicine | 5501005659 | OH |
NPI | 1346323458 |
---|---|
Provider Name | Dr. Melda Luzadas |
First Address | Sylvania, OH 43560-2206 |
Second Address | Dearborn, MI 48126-2916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |