Individual
LUIS F. DOMENECH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1385 EAST EMPIRE AVENUE, BENTON HARBOR, MI 49022-2037
(800) 979-9595
(248) 662-9845
Mailing address
21333 HAGGERTY RD., SUITE 150, NOVI, MI 48375-5514
(248) 662-0250
(248) 662-9845
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301077232
MI
208D00000X
General Practice Physician
9465
PR
Other
Enumeration date
12/13/2006
Last updated
12/15/2020
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