MEDICARE: ERIN WILLIS LOUCKS 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	208000000X	Pediatrics Physician	22785	NE

General Provider Information

NPI Number	:	1235220120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN WILLIS LOUCKS M.D.

Provider Business Mailing Address
First Line	:	4325 DODGE STREET
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68132
Country	:	US
Telephone Number	:	402-955-7676
Fax Number	:	402-955-7679

Provider Business Practice Location Address
First Line	:	4835 DODGE ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68132-3133
Country	:	US
Telephone Number	:	402-955-7676
Fax Number	:

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	08/26/2024

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