Provider Demographics
NPI:1558356543
Name:LUZANIA, RANDY C (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:C
Last Name:LUZANIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 W 119TH ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3721
Mailing Address - Country:US
Mailing Address - Phone:913-345-3650
Mailing Address - Fax:913-345-3807
Practice Address - Street 1:5701 W 119TH ST
Practice Address - Street 2:SUITE 135
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3721
Practice Address - Country:US
Practice Address - Phone:913-451-1311
Practice Address - Fax:913-451-7511
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD 111595207Q00000X
KS04-26419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100453360DMedicaid
MO209192806Medicaid
MO1558356543Medicaid
KSP039465Medicare PIN
MO209192806Medicaid