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Individual

LUIS A TRUJILLO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
515 QUARTER ST, GLADWIN, MI 48624-1959
(989) 426-9286
Mailing address
2510 ABBOTT RD, MIDLAND, MI 48642-5006

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
4301071407
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
071407
MI
208M00000X
Hospitalist Physician
071407
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0106510712
BLUE SHIELD
MI
01
0F71000
BCBS
MI
05
1821042094
MI
05
4769870
MI
01
LT071407
BLUE CROSS BLUE SHIELD
MI
Enumeration date
05/20/2006
Last updated
04/20/2010
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