Provider Demographics
NPI:1568490555
Name:LUKSUS, KEVIN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOHN
Last Name:LUKSUS
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:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0652
Mailing Address - Country:US
Mailing Address - Phone:765-599-3400
Mailing Address - Fax:765-599-3500
Practice Address - Street 1:2200 FOREST RIDGE PKWY
Practice Address - Street 2:SUITE #310
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2943
Practice Address - Country:US
Practice Address - Phone:765-599-3400
Practice Address - Fax:765-599-3500
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038635A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100196570Medicaid
INP01438440OtherRAIL ROAD MEDICARE
INP00714996OtherRAILROAD INDIVIDUAL
INDC3600OtherRAILROAD GROUP
IN100196570Medicaid
IN220620F8Medicare PIN
IN197630EMedicare PIN
INDC3600OtherRAILROAD GROUP
INF25288Medicare UPIN
IN509840BMedicare PIN