Provider Demographics
NPI:1861829715
Name:DR.BIJU MATHEW LUKOSE MD FACS P.L.L.C.
Entity Type:Organization
Organization Name:DR.BIJU MATHEW LUKOSE MD FACS P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BIJU
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-358-0435
Mailing Address - Street 1:2705 DAMSEL BELLA BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-6169
Mailing Address - Country:US
Mailing Address - Phone:469-546-5304
Mailing Address - Fax:
Practice Address - Street 1:4541 N JOSEY LN STE 110
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4622
Practice Address - Country:US
Practice Address - Phone:469-546-5304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty