Healthcare Provider Details

I. General information

NPI: 1669867008
Provider Name (Legal Business Name): LUKE ENGELMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

1916 NW 37TH ST
OKLAHOMA CITY OK
73118-2811
US

V. Phone/Fax

Practice location:
  • Phone: 816-234-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-41104
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: