Provider Demographics
NPI:1336185420
Name:TREMONT-LUKATS, IVO W (MD)
Entity Type:Individual
Prefix:
First Name:IVO
Middle Name:W
Last Name:TREMONT-LUKATS
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 1:1515 HOLCOMBE BLVD
Mailing Address - Street 2:UNIT 431
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4000
Mailing Address - Country:US
Mailing Address - Phone:713-792-2883
Mailing Address - Fax:713-794-4999
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:UNIT 431
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:713-792-2883
Practice Address - Fax:713-794-4999
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1999762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202030701Medicaid
TXHO8555Medicare UPIN
H08555Medicare UPIN