Healthcare Provider Details

I. General information

NPI: 1962151894
Provider Name (Legal Business Name): MR. CHARLES OBASI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2022
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 SE ONYX DR
LEES SUMMIT MO
64063-5132
US

IV. Provider business mailing address

328 SE ONYX DR
LEES SUMMIT MO
64063-5132
US

V. Phone/Fax

Practice location:
  • Phone: 816-325-9455
  • Fax:
Mailing address:
  • Phone: 816-325-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: