Healthcare Provider Details

I. General information

NPI: 1033378708
Provider Name (Legal Business Name): KATARZYNA DERLUKIEWICZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PROGRESS RD
HANNIBAL MO
63401
US

IV. Provider business mailing address

900 E. LA HARPE ST
KIRKSVILLE MO
63501
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-8300
  • Fax:
Mailing address:
  • Phone: 660-665-1962
  • Fax: 660-665-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number2008018541
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2008018541
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2008018541
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: