Individual
DR. MATTHEW L LUKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
802 N RIVERSIDE RD, SUITE 200, SAINT JOSEPH, MO 64507-9794
(816) 271-6666
(816) 271-1300
Mailing address
802 N RIVERSIDE RD STE 200, SAINT JOSEPH, MO 64507-2553
(816) 271-6666
(816) 271-1300
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
2004009702
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200264130A
—
KS
05
—
208994400
—
MO
01
—
P00153146
RR MEDICARE
MO
Enumeration date
10/13/2006
Last updated
11/21/2017
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