Healthcare Provider Details

I. General information

NPI: 1275730988
Provider Name (Legal Business Name): TINA HONG LUO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONROE AVE NW
GRAND RAPIDS MI
49503-1455
US

IV. Provider business mailing address

3933 OAKCREST CT SE
GRAND RAPIDS MI
49546-9244
US

V. Phone/Fax

Practice location:
  • Phone: 616-732-6200
  • Fax: 616-732-6255
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301090612
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: