Organization
LUIS POMODORO M D PC
Active
Other names
LUIS POMODORO M D P C
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUIS A. POMODORO M.D. (PRESIDENT)
(734) 425-5320
Entity
Organization
Contact information
Practice address
15645 FARMINGTON RD, LIVONIA, MI 48154-2851
(734) 425-5320
(734) 425-6212
Mailing address
15645 FARMINGTON RD, LIVONIA, MI 48154-2851
(734) 425-5320
(734) 425-6212
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301037706
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036223
VALUE OPTIONS
MI
01
—
118156
CARE CHOICES
MI
05
—
1958828
—
MI
01
—
2608203502
BLUE CROSS BLUE SHIELD
MI
Enumeration date
08/24/2006
Last updated
01/17/2008
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