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Contact Information

ALLAN J LUISTRO, MD
1104 7TH AVE S.
BOX 92 MSUM HENDRIX CLINIC & COUNSELING CENTER
MOORHEAD, MN56563
 Phone: 218-477-2211
 Fax: 218-477-5867
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for ALLAN J LUISTRO · (Male)

NPI # 1073648259
Status Active
Credentials MD
Entity Individual
Enumeration date 02/21/2007
Last updated 02/22/2012 - About 14 years ago
Sole proprietor 1 Yes
Identifiers
  • MN License # 37656
  • MN Medicaid 804733200
  • ND Medicaid 17256
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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