Provider Demographics
NPI:1053501809
Name:LUKOSE, BIJU M (MD)
Entity Type:Individual
Prefix:
First Name:BIJU
Middle Name:M
Last Name:LUKOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 N JOSEY LN STE 110
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4622
Mailing Address - Country:US
Mailing Address - Phone:469-788-8588
Mailing Address - Fax:469-788-7800
Practice Address - Street 1:4541 N JOSEY LANE
Practice Address - Street 2:SUITE 110
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4622
Practice Address - Country:US
Practice Address - Phone:469-788-8588
Practice Address - Fax:469-788-7800
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254454207P00000X, 208600000X, 208D00000X
TXM7387207P00000X, 208600000X, 208D00000X
TXM7383208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188486815Medicaid