Individual
DR. LUIS ALBERTO GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3505 LAKE CITY HWY, WARSAW, IN 46580-3942
(574) 269-4144
(574) 268-2281
Mailing address
PO BOX 13008, LANSING, MI 48901-3008
(517) 364-6253
(517) 364-6208
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01080663A
IN
207V00000X
Obstetrics & Gynecology Physician
4301054514
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1603304641
BCBS INDIVIDUAL PIN
MI
05
—
2868162
—
MI
05
—
4288420
—
MI
Enumeration date
10/06/2006
Last updated
10/01/2020
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