Provider Demographics
NPI:1801385604
Name:EGBEDEJU, MONDAY
Entity Type:Individual
Prefix:
First Name:MONDAY
Middle Name:
Last Name:EGBEDEJU
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 1:3645 N WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-2312
Mailing Address - Country:US
Mailing Address - Phone:816-437-4789
Mailing Address - Fax:
Practice Address - Street 1:3645 N WAYNE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-2312
Practice Address - Country:US
Practice Address - Phone:816-437-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care