Provider Demographics
NPI:1780663922
Name:CONSTAN, LOUIS L (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:L
Last Name:CONSTAN
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 1:3350 SHATTUCK RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3287
Mailing Address - Country:US
Mailing Address - Phone:989-792-1895
Mailing Address - Fax:989-792-2235
Practice Address - Street 1:3350 SHATTUCK RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3287
Practice Address - Country:US
Practice Address - Phone:989-792-1895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2107392Medicaid
MIP18110001Medicare ID - Type UnspecifiedMEDICARE
MI2107392Medicaid