Individual
DR. ALFONSO GENERALAO LLANTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3973 M140, WATERVLIET, MI 49098
(269) 463-5711
(269) 463-2885
Mailing address
POB 127, WATERVLIET, MI 49098
(269) 463-5711
(269) 463-2885
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
AL038737
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1101156072
BCBS PIN #
MI
05
—
2093395
—
MI
Enumeration date
07/25/2008
Last updated
07/25/2008
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