MEDICARE: MR. KEVIN D. LAUCK 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	363A00000X	Physician Assistant	1040	NE

General Provider Information

NPI Number	:	1598713885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN D. LAUCK PA-C

Provider Business Mailing Address
First Line	:	PO BOX 357
Second Line	:
City	:	BLOOMFIELD
State	:	NE
Zip	:	68718-0357
Country	:	US
Telephone Number	:	402-373-4341
Fax Number	:	402-373-4344

Provider Business Practice Location Address
First Line	:	110 E MAIN ST
Second Line	:
City	:	BLOOMFIELD
State	:	NE
Zip	:	68718-4408
Country	:	US
Telephone Number	:	402-373-4341
Fax Number	:	402-373-4344

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	12/31/2007

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