Provider Demographics
NPI:1699731265
Name:LUJAN, HENRY (MD LLC)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:LUJAN
Suffix:
Gender:M
Credentials:MD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 NW 12TH AVE
Mailing Address - Street 2:SUITE 810
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1051
Mailing Address - Country:US
Mailing Address - Phone:305-585-6649
Mailing Address - Fax:
Practice Address - Street 1:9195 SUNSET DR
Practice Address - Street 2:SUITE 230
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3452
Practice Address - Country:US
Practice Address - Phone:786-279-6960
Practice Address - Fax:305-279-1994
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070394208C00000X
FLME 70394208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252543700Medicaid
FL252543700Medicaid
FL41360Medicare ID - Type Unspecified