Healthcare Provider Details

I. General information

NPI: 1740698554
Provider Name (Legal Business Name): EBEN ENO MBEI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 GLENN HENDREN DR STE 306
LIBERTY MO
64068-3388
US

IV. Provider business mailing address

2521 GLENN HENDREN DR STE 306
LIBERTY MO
64068-3388
US

V. Phone/Fax

Practice location:
  • Phone: 816-407-5430
  • Fax:
Mailing address:
  • Phone: 816-407-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2017033190
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: