Provider Demographics
NPI:1770869455
Name:LUKMAN A. SANUSI, M.D., PLLC
Entity type:Organization
Organization Name:LUKMAN A. SANUSI, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKMAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANUSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-688-4259
Mailing Address - Street 1:2421 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1883
Mailing Address - Country:US
Mailing Address - Phone:361-888-8893
Mailing Address - Fax:361-888-9446
Practice Address - Street 1:2421 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1883
Practice Address - Country:US
Practice Address - Phone:361-888-8893
Practice Address - Fax:361-888-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7341302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization