Provider Demographics
NPI:1710447255
Name:MIRABELLI, LUKE GILDO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:GILDO
Last Name:MIRABELLI
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 1:3901 RAINBOW BLVD # MS 1060
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8500
Mailing Address - Country:US
Mailing Address - Phone:913-588-5000
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD # MS 1060
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-5276
Practice Address - Fax:913-588-3974
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230253412084P0800X
KS94-098052084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS94-09805OtherKANSAS STATE BOARD OF HEALING ARTS
MO2023025341OtherMISSOURI STATE BOARD OF REGISTRATION FOR THE HEALING ARTS