Individual
DR. LUIS RAUL COLLAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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