MEDICARE: DR. HERMAN H LUCKE PH D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY01499	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	18054018	OTHER	MO	BCBS MISSOURI
3	701737	OTHER	KS	BCBS KANSAS

General Provider Information

NPI Number	:	1760541684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERMAN H LUCKE PH D

Provider Business Mailing Address
First Line	:	7280 NW 87TH TER STE 210
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-3706
Country	:	US
Telephone Number	:	816-587-2626
Fax Number	:	816-587-2627

Provider Business Practice Location Address
First Line	:	7280 NW 87TH TER
Second Line	:	SUITE 210
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-3720
Country	:	US
Telephone Number	:	816-587-2626
Fax Number	:	816-587-2627

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	01/04/2014

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