Healthcare Provider Details

I. General information

NPI: 1174337547
Provider Name (Legal Business Name): JOHN LUDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11305 ASH ST
LEAWOOD KS
66211-1643
US

IV. Provider business mailing address

22527 W 64TH TER
SHAWNEE KS
66226-3117
US

V. Phone/Fax

Practice location:
  • Phone: 913-345-8020
  • Fax:
Mailing address:
  • Phone: 913-660-2698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: