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NPI Code Detail

MEDICARE: LUIS F. DOMENECH M.D.

MEDICARE: LUIS F. DOMENECH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician4301077232MI
2208D00000XGeneral Practice Physician9465PR

General Provider Information

NPI Number : 1275694242
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUIS F. DOMENECH M.D.
Provider Business Mailing Address
First Line : 21333 HAGGERTY RD.
Second Line : SUITE 150
City : NOVI
State : MI
Zip : 48375-5514
Country : US
Telephone Number : 248-662-0250
Fax Number : 248-662-9845
Provider Business Practice Location Address
First Line : 1385 EAST EMPIRE AVENUE
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-2037
Country : US
Telephone Number : 800-979-9595
Fax Number : 248-662-9845
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 12/15/2020

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