Provider Demographics
NPI:1124591185
Name:BOYEDE, LAQUITA PATRICE (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAQUITA
Middle Name:PATRICE
Last Name:BOYEDE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:638 SOUTH IDA STREET DYNAMIC MEDICAL SERVICES LLC.
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211
Mailing Address - Country:US
Mailing Address - Phone:240-505-1283
Mailing Address - Fax:316-395-1110
Practice Address - Street 1:1503 NORTHEAST PARKWAY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214
Practice Address - Country:US
Practice Address - Phone:877-340-3242
Practice Address - Fax:316-395-1110
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies