Healthcare Provider Details

I. General information

NPI: 1366183832
Provider Name (Legal Business Name): PATRICK JASON EGBERUARE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NE SAINT LUKES BLVD
LEES SUMMIT MO
64086-6000
US

IV. Provider business mailing address

901 E 104TH ST # MS 400S
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-0340
  • Fax:
Mailing address:
  • Phone: 816-932-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2025030752
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: