MEDICARE: KAMAL SELIM LOUKA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101036392	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00W135E02	OTHER	VA	MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417900119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMAL SELIM LOUKA M.D.

Provider Business Mailing Address
First Line	:	4867 BAXTER RD
Second Line	:	SUITE 105
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4469
Country	:	US
Telephone Number	:	757-473-9300
Fax Number	:	757-473-9361

Provider Business Practice Location Address
First Line	:	4867 BAXTER RD
Second Line	:	SUITE 105
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4469
Country	:	US
Telephone Number	:	757-473-9300
Fax Number	:	757-473-9361

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	10/24/2007

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