MEDICARE: DR. LUKMAN ADESOLA SANUSI 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	01063601A	IN
2	207Q00000X	Family Medicine Physician	50332	MN

General Provider Information

NPI Number	:	1639377278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUKMAN ADESOLA SANUSI M.D.

Provider Business Mailing Address
First Line	:	2421 MORGAN AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78405-1883
Country	:	US
Telephone Number	:	361-688-4259
Fax Number	:

Provider Business Practice Location Address
First Line	:	2421 MORGAN AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78405-1883
Country	:	US
Telephone Number	:	361-688-4259
Fax Number	:

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

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	08/11/2011

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