Provider Demographics
NPI:1427050160
Name:LOUCAS, EMMANUEL (MD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:LOUCAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 PGA BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2910
Mailing Address - Country:US
Mailing Address - Phone:561-693-0540
Mailing Address - Fax:561-422-4212
Practice Address - Street 1:121 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4338
Practice Address - Country:US
Practice Address - Phone:561-693-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199503207N00000X
FLME143732207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY220151Medicare PIN
F47655Medicare UPIN