Provider Demographics
NPI:1033224217
Name:CAMERO, LUIS GABRIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:GABRIEL
Last Name:CAMERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23715 LITTLE MACK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1181
Mailing Address - Country:US
Mailing Address - Phone:586-447-8021
Mailing Address - Fax:586-447-8022
Practice Address - Street 1:23715 LITTLE MACK AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1181
Practice Address - Country:US
Practice Address - Phone:586-447-8021
Practice Address - Fax:586-447-8022
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034441208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP41778OtherBLUE CARE NETWORK
MI1575219Medicaid
MI3305000291OtherBCBSM
MI70101AOtherHEALTH ALLIANCE PLAN
MI1575219Medicaid
MI0500029Medicare ID - Type Unspecified