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General NPI Number Information
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NPI Number | 1871271825
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Entity Type | Individual
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Provider Name | CHANTAL E LUJANO
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Gender | Female
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 401 S BALLENGER HWY
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City | FLINT
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State | MI
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Zip | 48532-3638
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Country | US
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Telephone | 810-342-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 BRISBANE ST
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City | WOLVERINE LAKE
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State | MI
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Zip | 48390-1830
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Country | US
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Telephone | 517-375-9870
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601011602
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License Number State | MI
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