Provider Demographics
NPI:1225077522
Name:BOYAJIAN-ONEILL, LORI (DO)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:BOYAJIAN-ONEILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19550 E 39TH ST S STE 230B
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2358
Mailing Address - Country:US
Mailing Address - Phone:816-795-8200
Mailing Address - Fax:816-795-7735
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:SUITE 419
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2358
Practice Address - Country:US
Practice Address - Phone:816-795-8200
Practice Address - Fax:816-795-7735
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO9N50207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1225077522Medicaid
080135930OtherRAILROAD MEDICARE
MO243565322Medicaid
MO080135930OtherRAILROAD MEDICARE
KS200584170AMedicaid
KS200584170BMedicaid
E44530Medicare UPIN
MOP00703585Medicare PIN
MO080135930OtherRAILROAD MEDICARE
2303466Medicare ID - Type Unspecified