Individual
REEJU ELLOOKUNNEL LUKOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6550 FANNIN ST, SUITE 2600, HOUSTON, TX 77030-2717
(713) 790-1818
(713) 790-7500
Mailing address
6550 FANNIN ST, SUITE 2600, HOUSTON, TX 77030-2717
(713) 790-1818
(713) 790-7500
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
014197
NY
363AS0400X
Surgical Physician Assistant
Primary
PA09978
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
356622602
—
TX
01
—
8800NV
BLUE CROSS BLUE SHIELD
TX
Enumeration date
11/30/2010
Last updated
08/30/2016
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