Healthcare Provider Details

I. General information

NPI: 1033224217
Provider Name (Legal Business Name): LUIS GABRIEL CAMERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23715 LITTLE MACK AVE STE 100
SAINT CLAIR SHORES MI
48080-1181
US

IV. Provider business mailing address

23715 LITTLE MACK AVE STE 100
SAINT CLAIR SHORES MI
48080-1181
US

V. Phone/Fax

Practice location:
  • Phone: 586-447-8021
  • Fax: 586-447-8022
Mailing address:
  • Phone: 586-447-8021
  • Fax: 586-447-8022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number4301034441
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: