Healthcare Provider Details

I. General information

NPI: 1992257992
Provider Name (Legal Business Name): LUELLEN MALLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUELLEN HULL M.D.

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14105 NW 74TH ST
KANSAS CITY MO
64152-5115
US

IV. Provider business mailing address

14105 NW 74TH ST
KANSAS CITY MO
64152-5115
US

V. Phone/Fax

Practice location:
  • Phone: 816-679-1573
  • Fax:
Mailing address:
  • Phone: 816-679-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberR8H66
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: