Provider Demographics
NPI:1275859290
Name:LUIS GABRIEL CAMERO, M.D.,P.C.
Entity Type:Organization
Organization Name:LUIS GABRIEL CAMERO, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:CAMERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-777-8440
Mailing Address - Street 1:25810 KELLY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4467
Mailing Address - Country:US
Mailing Address - Phone:586-777-8440
Mailing Address - Fax:586-777-3805
Practice Address - Street 1:25810 KELLY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4467
Practice Address - Country:US
Practice Address - Phone:586-777-8440
Practice Address - Fax:586-777-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
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
MI1575219Medicaid
MI43010344441OtherMICHIGAN LICENSE
MI0500029Medicare PIN
MI1575219Medicaid