Healthcare Provider Details

I. General information

NPI: 1700455706
Provider Name (Legal Business Name): CONNOR LUKE HOSTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 11/01/2024
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13643 S MUR LEN RD
OLATHE KS
66062
US

IV. Provider business mailing address

13643 S MUR LEN RD
OLATHE KS
66062
US

V. Phone/Fax

Practice location:
  • Phone: 913-764-3016
  • Fax: 913-764-8059
Mailing address:
  • Phone: 913-764-3016
  • Fax: 913-764-8059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2021023737
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: