Provider Demographics
NPI:1508061425
Name:EBERSOLE, KOJI CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:KOJI
Middle Name:CHRISTOPHER
Last Name:EBERSOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3901 RAINBOW BLVD # MS 3021
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8500
Mailing Address - Country:US
Mailing Address - Phone:913-588-6122
Mailing Address - Fax:913-945-8225
Practice Address - Street 1:3901 RAINBOW BLVD # MS 3021
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-6122
Practice Address - Fax:913-945-8225
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08066700207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery