| Victor Ivan Lugo-miro Md | |
|
3036 Northpark Dr Kingwood TX 77339-5114 | |
| (281) 360-8501 | |
| (281) 360-8617 |
| Full Name | Victor Ivan Lugo-miro Md |
|---|---|
| Speciality | Family Medicine |
| Location | 3036 Northpark Dr, Kingwood, Texas |
| Authorized Official Name and Position | Victor I Lugo Miro (CEO/OWNER) |
| Authorized Official Contact | 2813608501 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victor Ivan Lugo-miro Md 3036 Northpark Dr Kingwood TX 77339-5114 Ph: (281) 360-8501 | Victor Ivan Lugo-miro Md 3036 Northpark Dr Kingwood TX 77339-5114 Ph: (281) 360-8501 |
| NPI Number | 1861681975 |
|---|---|
| Provider Enumeration Date | 10/15/2007 |
| Last Update Date | 10/08/2009 |
| Medicare PECOS PAC ID | 6709805575 |
|---|---|
| Medicare Enrollment ID | O20091120000283 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861681975 | NPI | - | NPPES |
| 080241501 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | H6890 (Texas) | Primary |
| 208000000X | Pediatrics | H6890 (Texas) | Secondary |
| Provider Name | Yelena Krupnik |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568638450 PECOS PAC ID: 1153460795 Enrollment ID: I20091120000309 |
| Provider Name | Victor I Lugo Miro |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1104934017 PECOS PAC ID: 3971642513 Enrollment ID: I20091201000387 |
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