Healthcare Provider Details

I. General information

NPI: 1225077522
Provider Name (Legal Business Name): LORI BOYAJIAN-ONEILL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 W 143RD ST
OVERLAND PARK KS
66223-2174
US

IV. Provider business mailing address

13003 WALMER ST
OVERLAND PARK KS
66209-3616
US

V. Phone/Fax

Practice location:
  • Phone: 913-815-1861
  • Fax:
Mailing address:
  • Phone: 913-915-9887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberDO9N50
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: