Individual
LUIS A BARAJAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3170 WILLOWCREEK RD, PORTAGE, IN 46368-4424
(219) 764-7236
(219) 764-7507
Mailing address
3170 WILLOWCREEK RD, PORTAGE, IN 46368-4424
(219) 764-7236
(219) 764-7507
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
01050865A
IN
207Q00000X
Family Medicine Physician
Primary
01050865A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558361592
NPI
—
05
—
200279150
—
IN
Enumeration date
07/29/2005
Last updated
10/28/2020
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