Provider Demographics
NPI:1528092012
Name:CARVALHO, LUIS H (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:H
Last Name:CARVALHO
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 1:3438 GRANITE CIR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1160
Mailing Address - Country:US
Mailing Address - Phone:419-841-2303
Mailing Address - Fax:419-842-1161
Practice Address - Street 1:3438 GRANITE CIR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1160
Practice Address - Country:US
Practice Address - Phone:419-841-2303
Practice Address - Fax:419-842-1161
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-3030208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0387380Medicaid
OHCA0456274Medicare PIN
C01594Medicare UPIN