Provider Demographics
NPI:1619131513
Name:LUEDER, SUSHMA KANTHALA (MD)
Entity type:Individual
Prefix:DR
First Name:SUSHMA
Middle Name:KANTHALA
Last Name:LUEDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSHMA
Other - Middle Name:KANTHALA
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 CARONDELET DR
Mailing Address - Street 2:MAIL STOP #9
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4673
Mailing Address - Country:US
Mailing Address - Phone:816-943-4554
Mailing Address - Fax:
Practice Address - Street 1:1000 CARONDELET DR
Practice Address - Street 2:MAIL STOP #9
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4673
Practice Address - Country:US
Practice Address - Phone:816-943-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036126654208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL4145002Medicare PIN