Individual
AMY K LUCZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6550 FANNIN ST, SUITE 1401, HOUSTON, TX 77030-2717
(713) 441-5200
Mailing address
6550 FANNIN ST, SUITE 1401, HOUSTON, TX 77030-2717
(713) 441-5200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA05821
TX
363AS0400X
Surgical Physician Assistant
PA05821
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487884672
BLUE CROSS BLUE SHIELD
TX
05
—
209315504
—
TX
05
—
209315505
—
TX
01
—
884N22
BCBS
TX
01
—
P01152529
RR MEDICARE
TX
01
—
P01337851
RR MEDICARE
TX
Enumeration date
07/22/2009
Last updated
02/01/2017
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