Provider Demographics
NPI:1154586451
Name:LLANTO, ALFONSO GENERALAO (MD)
Entity type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:GENERALAO
Last Name:LLANTO
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:POB 127
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:MI
Mailing Address - Zip Code:49098
Mailing Address - Country:US
Mailing Address - Phone:269-463-5711
Mailing Address - Fax:269-463-2885
Practice Address - Street 1:3973 M140
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:MI
Practice Address - Zip Code:49098
Practice Address - Country:US
Practice Address - Phone:269-463-5711
Practice Address - Fax:269-463-2885
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL038737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2093395Medicaid
MI1101156072OtherBCBS PIN #
MI1101156072OtherBCBS PIN #
MI0115607Medicare PIN