Healthcare Provider Details

I. General information

NPI: 1528292570
Provider Name (Legal Business Name): OLAJIDE KAYODE OGUNTUASE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 10/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 19TH TER
KANSAS CITY MO
64108-2026
US

IV. Provider business mailing address

2310 HOLMES ST STE 800
KANSAS CITY MO
64108-2602
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-5700
  • Fax:
Mailing address:
  • Phone: 816-218-2523
  • Fax: 816-421-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2013002816
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: