MR. KIM LADELL LUSTER NPI 1396870051

NPI Information

  • NPI: 1396870051
  • Provider Name: MR. KIM LADELL LUSTER
  • Classification: - 246ZS0400X
  • Entity Type: Individual
  • Address: 2400 N SAMSON WAY
    APT#2D
    WAUKEGAN, IL
    ZIP 60087
  • Phone: (122) 439-9931

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NPI Details

MR. Kim Ladell Luster is a healthcare provider in Waukegan, IL. MR. Kim Ladell Luster NPI is 1396870051. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2400 N SAMSON WAY
APT#2D
WAUKEGAN, IL
ZIP 60087-079
Phone: (122) 439-9931
Fax: (122) 494-4008

The enumeration date for this NPI number is 2/22/2007 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1246ZS0400XILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

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