Provider Demographics
NPI:1013172063
Name:TELUFUSI, LUKMAN O (PA)
Entity Type:Individual
Prefix:
First Name:LUKMAN
Middle Name:O
Last Name:TELUFUSI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GREENWAY PLZ
Mailing Address - Street 2:SUITE 2950
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0905
Mailing Address - Country:US
Mailing Address - Phone:713-935-0333
Mailing Address - Fax:
Practice Address - Street 1:19900 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6505
Practice Address - Country:US
Practice Address - Phone:281-341-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05788363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L10411Medicare PIN
TX8L10413Medicare PIN
8L10414Medicare PIN
TX8L14190Medicare PIN
TX8L10412Medicare PIN
TX8L10410Medicare PIN