Provider Demographics
NPI:1467549329
Name:EKUNNO, JOSIAH O
Entity Type:Individual
Prefix:DR
First Name:JOSIAH
Middle Name:O
Last Name:EKUNNO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 410858
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-355-6218
Mailing Address - Fax:314-355-1092
Practice Address - Street 1:11125 DUNN ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136
Practice Address - Country:US
Practice Address - Phone:314-355-6218
Practice Address - Fax:314-355-1092
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35803207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200927101Medicaid
MO000001064Medicare ID - Type Unspecified
A09739Medicare UPIN