Healthcare Provider Details

I. General information

NPI: 1699731265
Provider Name (Legal Business Name): HENRY LUJAN MD LLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9195 SUNSET DR SUITE 230
MIAMI FL
33173-3452
US

IV. Provider business mailing address

1500 NW 12TH AVE SUITE 810
MIAMI FL
33136-1051
US

V. Phone/Fax

Practice location:
  • Phone: 786-279-6960
  • Fax: 305-279-1994
Mailing address:
  • Phone: 305-585-6649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME0070394
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME 70394
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: