Individual
DR. LUISITO C. GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
303 S NAPPANEE ST, SUITE A, ELKHART, IN 46514-2066
(574) 296-3338
(574) 296-3332
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01046919A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000691249
ANTHEM BCBS
IN
01
—
000000851248
BCBS ELKHART CARDIOLOGY
IN
05
—
200138970
—
IN
05
—
200148970
—
IN
01
—
P01317343
RR MEDICARE
IN
Enumeration date
05/24/2005
Last updated
03/16/2016
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