Provider Demographics
NPI:1558364067
Name:COBBINAH, INGENUE FAITH (MD)
Entity Type:Individual
Prefix:
First Name:INGENUE
Middle Name:FAITH
Last Name:COBBINAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E. 104TH ST.
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-502-7104
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:2737 NE MCBAINE DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-7880
Practice Address - Country:US
Practice Address - Phone:816-251-5780
Practice Address - Fax:816-251-5781
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112413207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208716720Medicaid
MO208716720Medicaid
MO252A175AMedicare ID - Type UnspecifiedMEDICARE NUMBER