Provider Demographics
NPI:1336527134
Name:BADJALIMBE, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BADJALIMBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10977 GRANADA LN STE 105
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1415
Mailing Address - Country:US
Mailing Address - Phone:816-822-0050
Mailing Address - Fax:816-447-3960
Practice Address - Street 1:10977 GRANADA LN STE 105
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1415
Practice Address - Country:US
Practice Address - Phone:816-822-0050
Practice Address - Fax:816-447-3960
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76705-062207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine