Provider Demographics
NPI:1629071287
Name:POSTIGO, LUIS G (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:G
Last Name:POSTIGO
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 1:115 POSTIGO LAKEVIEW
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9053
Mailing Address - Country:US
Mailing Address - Phone:585-872-2710
Mailing Address - Fax:972-236-5360
Practice Address - Street 1:115 POSTIGO LAKEVIEW
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-9053
Practice Address - Country:US
Practice Address - Phone:585-872-2710
Practice Address - Fax:972-236-5360
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240594207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02887341Medicaid
NYOTH000Medicare UPIN