Provider Demographics
NPI:1609921196
Name:LUKE J DLABAL JR MD PC
Entity Type:Organization
Organization Name:LUKE J DLABAL JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:DLABAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:816-347-1514
Mailing Address - Street 1:3601 NE RALPH POWELL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2357
Mailing Address - Country:US
Mailing Address - Phone:816-347-1514
Mailing Address - Fax:816-347-1822
Practice Address - Street 1:3601 NE RALPH POWELL RD
Practice Address - Street 2:SUITE C
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2357
Practice Address - Country:US
Practice Address - Phone:816-347-1514
Practice Address - Fax:816-347-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOM030680207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0003054Medicare ID - Type Unspecified
D90214Medicare UPIN