Healthcare Provider Details

I. General information

NPI: 1154633170
Provider Name (Legal Business Name): LUCAS THOMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD MS4010 FAM MED RESIDENCY OFFICE
KANSAS CITY KS
66103-2937
US

IV. Provider business mailing address

3901 RAINBOW BLVD MS4010 FAM MED RESIDENCY OFFICE
KANSAS CITY KS
66103-2937
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1902
  • Fax: 913-588-1951
Mailing address:
  • Phone: 913-588-1902
  • Fax: 913-588-1951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number94-07568
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: