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General NPI Number Information
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NPI Number | 1306383294
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Entity Type | Organization
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Legal Business Name | LITTLE LANTERN CARE
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 4541 N JOSEY LN STE 110
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City | CARROLLTON
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State | TX
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Zip | 75010-4622
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Country | US
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Telephone | 469-788-8588
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Fax | 469-788-7800
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Provider Business Mailing Address
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Address Line | 2705 DAMSEL BELLA BLVD
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City | THE COLONY
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State | TX
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Zip | 75056-6169
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Country | US
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Telephone | 469-850-2677
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Fax | 940-400-2582
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Authorized Official
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Title or Position | CEO
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Name | DR. BIJU M LUKOSE
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Credential |
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Telephone | 469-546-5304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | M7387
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M7387
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License Number State | TX
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