Basic Information
Provider Information
NPI: 1003298811
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VOCELKA
FirstName: LUCAS
MiddleName:  
NamePrefix:  
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Credential: DO
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Mailing Information
Address1: 901 MCCLINTOCK DR STE 202
Address2:  
City: BURR RIDGE
State: IL
PostalCode: 605270872
CountryCode: US
TelephoneNumber: 6306556748
FaxNumber: 6307344715
Practice Location
Address1: 2340 E MEYER BLVD, BLDG 2
Address2: SUITE 392
City: KANSAS CITY
State: MO
PostalCode: 641326413
CountryCode: US
TelephoneNumber: 8164447977
FaxNumber: 6305289578
Other Information
ProviderEnumerationDate: 06/29/2015
LastUpdateDate: 07/16/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialCredential:  
NPICertificationDate: 07/16/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200X05-43061KSN Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
207RI0200X2020009401MOY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


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