Active NPI
Luis Pomodoro M D PC
- Psychiatry Physician
- Livonia, MI
National Provider Identifier
1043327935
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 4301037706
- Legal business name
- LUIS POMODORO M D PC
- Practice address
- 15645 Farmington Rd
Livonia, MI 48154-2851 - Phone
- (734) 425-5320
- Fax
- (734) 425-6212
- NPI assigned
- Aug 24, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Luis A. Pomodoro, M.D.
- Title
- President
- Phone
- (734) 425-5320
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 4301037706 | MI | Primary |
Addresses
Primary practice location
15645 Farmington Rd
Livonia, MI 48154-2851
Mailing address
15645 Farmington Rd
Livonia, MI 48154-2851
Phone (734) 425-5320
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 118156 | Other | MI | CARE CHOICES |
| 2608203502 | Other | MI | BLUE CROSS BLUE SHIELD |
| 118156 | Other | MI | PREFERRED CHOICES |
| 036223 | Other | MI | VALUE OPTIONS |
| 1958828 | Medicaid | MI |
Other names 1
- LUIS POMODORO M D P C
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156377600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1200528000000",
"number": "1043327935",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15645 FARMINGTON RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481542851",
"telephone_number": "734-425-5320",
"fax_number": "734-425-6212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15645 FARMINGTON RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481542851",
"telephone_number": "734-425-5320",
"fax_number": "734-425-6212"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LUIS POMODORO M D PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-24",
"last_updated": "2008-01-17",
"status": "A",
"authorized_official_last_name": "POMODORO",
"authorized_official_first_name": "LUIS",
"authorized_official_middle_name": "A.",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "734-425-5320",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MI",
"license": "4301037706",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARE CHOICES",
"identifier": "118156",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "2608203502",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CHOICES",
"identifier": "118156",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "036223",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1958828",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "LUIS POMODORO M D P C",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Livonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.