MEDICARE: MS. RACHEL LUKOSE PA-C

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	363AS0400X	Surgical Physician Assistant	PA15993	TX

General Provider Information

NPI Number	:	1699491514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL LUKOSE PA-C

Provider Business Mailing Address
First Line	:	5318 DALTON RANCH LN
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4523
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 FANNIN ST STE 1600
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1527
Country	:	US
Telephone Number	:	508-308-8189
Fax Number	:

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

Provider Enumeration Date	:	10/12/2022
Last Update Date	:	11/02/2022

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