Provider Demographics
NPI:1851447049
Name:HOBSON, MANA (MD)
Entity Type:Individual
Prefix:
First Name:MANA
Middle Name:
Last Name:HOBSON
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 1:7900 LEES SUMMIT RD
Mailing Address - Street 2:TMC LAKEWOOD
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64139-1236
Mailing Address - Country:US
Mailing Address - Phone:816-404-7650
Mailing Address - Fax:
Practice Address - Street 1:606 S HARDY AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64053-1827
Practice Address - Country:US
Practice Address - Phone:816-404-5770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59657207RG0300X
MO2016031447207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G59767100Medicaid
CA207RG0300XOtherTAXONOMY CODE
CA207RG0300XOtherTAXONOMY CODE
CA02-0691877OtherTAX ID NUMBER
CA00G59767100Medicaid