Provider Demographics
NPI:1790758746
Name:GARRASTEGUI, LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:GARRASTEGUI
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 1:4915 CLAREMONT ST
Mailing Address - Street 2:#2
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-3387
Mailing Address - Country:US
Mailing Address - Phone:989-837-1438
Mailing Address - Fax:
Practice Address - Street 1:4915 CLAREMONT ST
Practice Address - Street 2:#2
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-3387
Practice Address - Country:US
Practice Address - Phone:989-837-1438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067027146D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine