1609944578 NPI number — JOSEPH B. LUNA M.D., P.C.

Table of content: (NPI 1609944578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609944578 NPI number — JOSEPH B. LUNA M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH B. LUNA M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609944578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 253
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVISON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48423-0253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-658-8343
Provider Business Mailing Address Fax Number:
810-658-3743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1510 S STATE RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
DAVISON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48423-1965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-658-8343
Provider Business Practice Location Address Fax Number:
810-658-3743
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUNA
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
BENJAMIN
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
810-658-8343

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  4301068184 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0984977 . This is a "HEALTHPLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3502511391 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 10 4670463 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0984977 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139950 . This is a "PREFERRED CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 139950 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3502511391 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 725-1 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: G97184 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1012600 . This is a "MCLAREN HEALTH ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7607664 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1012600 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2281218 . This is a "FIRST HEALTH NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: MCARE . This is a "C6592" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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