Provider Demographics
NPI:1821352782
Name:VAN KIRK, LUKE A (DO)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:A
Last Name:VAN KIRK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3238 S NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7303
Mailing Address - Country:US
Mailing Address - Phone:417-351-2900
Mailing Address - Fax:417-351-2900
Practice Address - Street 1:3238 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7303
Practice Address - Country:US
Practice Address - Phone:417-351-2900
Practice Address - Fax:417-351-2900
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013027456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine