Healthcare Provider Details

I. General information

NPI: 1053346452
Provider Name (Legal Business Name): LUKE A WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8005 W 110TH ST STE 214
OVERLAND PARK KS
66210-2619
US

IV. Provider business mailing address

8005 W 110TH ST STE 214
OVERLAND PARK KS
66210-2619
US

V. Phone/Fax

Practice location:
  • Phone: 913-599-6777
  • Fax: 913-599-3955
Mailing address:
  • Phone: 913-599-6777
  • Fax: 913-599-3955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number04-29799
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2005014017
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number3914-320
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: