Basic Information
| Provider Information | |||||||||
| NPI: | 1497938104 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALAZAR | ||||||||
| FirstName: | LUIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6265 ROCK CHALK DR | ||||||||
| Address2: | SUITE 1500 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858439125 | ||||||||
| FaxNumber: | 7858433176 | ||||||||
| Practice Location | |||||||||
| Address1: | 6265 ROCK CHALK DR | ||||||||
| Address2: | SUITE 1500 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858439125 | ||||||||
| FaxNumber: | 7858433176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2007 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 436460 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207Q00000X | 436460 | KS | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.