Healthcare Provider Details

I. General information

NPI: 1003313438
Provider Name (Legal Business Name): LUCAS RYAN PHILIPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 E 39TH ST S STE 105
INDEPENDENCE MO
64057-1926
US

IV. Provider business mailing address

19550 E 39TH ST S STE 105
INDEPENDENCE MO
64057-1926
US

V. Phone/Fax

Practice location:
  • Phone: 816-350-4215
  • Fax: 816-350-4220
Mailing address:
  • Phone: 816-350-4215
  • Fax: 816-350-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2025047637
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: