Individual
DR. ALLAN JAMES LUISTRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1104 7TH AVE S., BOX 92 MSUM HENDRIX CLINIC & COUNSELING CENTER, MOORHEAD, MN 56563
(218) 477-2211
(218) 477-5867
Mailing address
5027 ROSE CREEK PKWY S, FARGO, ND 58104-6848
(701) 298-9024
(701) 297-0132
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37656
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17256
—
ND
05
—
804733200
—
MN
Enumeration date
02/21/2007
Last updated
02/22/2012
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