Provider Demographics
NPI:1962750620
Name:LUTHRA, SAURAV (MD)
Entity type:Individual
Prefix:
First Name:SAURAV
Middle Name:
Last Name:LUTHRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CAMBRIDGE ST
Mailing Address - Street 2:MAILSTOP 3007
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8501
Mailing Address - Country:US
Mailing Address - Phone:913-588-6045
Mailing Address - Fax:913-588-4098
Practice Address - Street 1:4000 CAMBRIDGE ST
Practice Address - Street 2:MAILSTOP 3007
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8501
Practice Address - Country:US
Practice Address - Phone:913-588-6045
Practice Address - Fax:913-588-4098
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY280302207R00000X, 208M00000X
KS04-44234207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04207558Medicaid
NYJ400236528/GRP70008AMedicare PIN
NY04207558Medicaid