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:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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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:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-098052084P0800X
MO20230253412084P0800X
UT13848425-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2023025341OtherMISSOURI STATE BOARD OF REGISTRATION FOR THE HEALING ARTS
KS94-09805OtherKANSAS STATE BOARD OF HEALING ARTS