Individual
DR. LUIS RAUL COLLAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
829 N CENTER AVE, SUITE 130, GAYLORD, MI 49735-1595
(989) 731-7930
(989) 731-7948
Mailing address
829 N CENTER AVE, SUITE 298, GAYLORD, MI 49735-1595
(989) 731-7708
(989) 731-7929
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301071438
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3506910402
BCBSM
MI
05
—
4943810
—
MI
Enumeration date
10/20/2005
Last updated
11/11/2020
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