Provider Demographics
NPI:1245295161
Name:BARBE, LUIS (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:BARBE
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 1:25990 KELLY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4483
Mailing Address - Country:US
Mailing Address - Phone:586-445-0950
Mailing Address - Fax:586-445-9866
Practice Address - Street 1:25990 KELLY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4483
Practice Address - Country:US
Practice Address - Phone:586-445-0950
Practice Address - Fax:586-445-9866
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILB034289208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3405003101OtherBCBSM
MI020042879OtherRAILROAD MEDICARE PIN
MI1099590Medicaid
MI1099590Medicaid
MI3405003101OtherBCBSM