Healthcare Provider Details

I. General information

NPI: 1053501809
Provider Name (Legal Business Name): BIJU M LUKOSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4541 N JOSEY LANE SUITE 110
CARROLLTON TX
75010-4622
US

IV. Provider business mailing address

4541 N JOSEY LN STE 110
CARROLLTON TX
75010-4622
US

V. Phone/Fax

Practice location:
  • Phone: 469-788-8588
  • Fax: 469-788-7800
Mailing address:
  • Phone: 469-788-8588
  • Fax: 469-788-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number254454
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM7387
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM7387
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM7383
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number254454
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number254454
License Number StateNY
# 7
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberM7387
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: