Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 05-43061 | KS |
Y | 207RI0200X | Infectious Disease | 2020009401 | MO |
NPI | 1003298811 |
---|---|
Provider Name | Lucas Vocelka |
First Address | Burr Ridge, IL 60527-0872 |
Second Address | Kansas City, MO 64132-6413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2015 |
Last Update Date | 16/07/2020 |