Provider Demographics
NPI:1730291154
Name:EHIMARE, PAPPA UMONOIBALO (MD)
Entity Type:Individual
Prefix:
First Name:PAPPA
Middle Name:UMONOIBALO
Last Name:EHIMARE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:UMONOIBALO
Other - Middle Name:
Other - Last Name:EHIMARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1800 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:660-890-8183
Mailing Address - Fax:660-890-8183
Practice Address - Street 1:1032 CROSSWINDS CT
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-4836
Practice Address - Country:US
Practice Address - Phone:888-403-1071
Practice Address - Fax:636-332-8213
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070160812084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry