MEDICARE: JOHN D LOUCKS

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	207Y00000X	Otolaryngology Physician	16446	KY

General Provider Information

NPI Number	:	1083682892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN D LOUCKS

Provider Business Mailing Address
First Line	:	2841 NEW HARTFORD RD
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-1320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2841 NEW HARTFORD RD
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-1320
Country	:	US
Telephone Number	:	270-691-6161
Fax Number	:

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	03/17/2014

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