Basic Information
| Provider Information | |||||||||
| NPI: | 1689726010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIJANI | ||||||||
| FirstName: | LUKMAN | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5865 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794085865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067433150 | ||||||||
| FaxNumber: | 8067433168 | ||||||||
| Practice Location | |||||||||
| Address1: | 602 INDIANA AVE | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794153364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067758600 | ||||||||
| FaxNumber: | 8067758602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 45237 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 45237 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1545048 | 01 | PA | PERSONAL CHOICE | OTHER | 1545048 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 1008309640002 | 05 | PA | MEDICAID | 2228842000 | 01 | PA | KEYSTONE,IBC | OTHER | 1008309640001 | 05 | PA | MEDICAID | 219696601 | 05 | TX | MEDICAID | 1008309640003 | 05 | PA | MEDICAID | 30016642 | 01 | PA | KEYSTONE MERCY | OTHER |