Basic Information
| Provider Information | |||||||||
| NPI: | 1568490555 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUKSUS | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 652 | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473620652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655993400 | ||||||||
| FaxNumber: | 7655993500 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 FOREST RIDGE PKWY | ||||||||
| Address2: | SUITE #310 | ||||||||
| City: | NEW CASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473622943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655993400 | ||||||||
| FaxNumber: | 7655993500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 05/15/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01038635A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100196570 | 05 | IN | MEDICAID | P01438440 | 01 | IN | RAIL ROAD MEDICARE | OTHER | P00714996 | 01 | IN | RAILROAD INDIVIDUAL | OTHER | DC3600 | 01 | IN | RAILROAD GROUP | OTHER |