Luis Felipe Fanego, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

LF053797 Issued in MI

Practice address

3180 Fort St
Lincoln Park, MI 48146-3631

Phone

(313) 389-5588

Fax

(313) 389-7075

NPI assigned

Sep 27, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639260573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3180 FORT ST",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481463631",
            "telephone_number": "313-389-5588",
            "fax_number": "313-389-7075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3180 FORT ST",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481463631",
            "telephone_number": "313-389-5588",
            "fax_number": "313-389-7075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANEGO",
        "first_name": "LUIS",
        "middle_name": "FELIPE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "LF053797",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "1108267832",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4121372",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Melissa R Flores, DO
• Caroline Florescu, M.D.

• Family Medicine Physician in Lincoln Park, MI
• Providers in Lincoln Park, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.