Individual
LUIS COLLAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
31022 UTICA RD., FRASER, MI 48026
(586) 298-6035
(586) 298-6099
Mailing address
31022 UTICA RD., FRASER, MI 48026
(586) 298-6035
(586) 298-6099
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
LC062191
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4321598
—
MI
Enumeration date
11/20/2006
Last updated
08/22/2011
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