MEDICARE: LUKMAN A. SANUSI, M.D., PLLC

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	302R00000X	Health Maintenance Organization	N7341	TX

General Provider Information

NPI Number	:	1770869455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUKMAN A. SANUSI, M.D., PLLC

Provider Business Mailing Address
First Line	:	2421 MORGAN AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78405-1883
Country	:	US
Telephone Number	:	361-888-8893
Fax Number	:	361-888-9446

Provider Business Practice Location Address
First Line	:	2421 MORGAN AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78405-1883
Country	:	US
Telephone Number	:	361-888-8893
Fax Number	:	361-888-9446

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LUKMAN A. SANUSI
Credential	:	M.D.
Telephone Number	:	361-688-4259

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	10/26/2011

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