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Individual

MR. CARLOS DANIEL LUIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ATC

Contact information

Practice address
12603 STATE ROUTE 143, STE. #8, HIGHLAND, IL 62249-1199
(618) 654-4701
(618) 654-4739
Mailing address
12603 STATE ROUTE 143, STE. #8, HIGHLAND, IL 62249-1199
(618) 654-4701
(618) 654-4739

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.003450
IL
2255A2300X
Athletic Trainer
2013023627
MO

Other

Enumeration date
09/12/2013
Last updated
09/12/2013
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