Healthcare Provider Details

I. General information

NPI: 1356962799
Provider Name (Legal Business Name): MINDSMATTERSMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 E SUNSHINE ST STE 603
SPRINGFIELD MO
65804-1333
US

IV. Provider business mailing address

1736 E SUNSHINE ST STE 603
SPRINGFIELD MO
65804-1333
US

V. Phone/Fax

Practice location:
  • Phone: 844-476-6600
  • Fax: 417-356-8078
Mailing address:
  • Phone: 844-476-6600
  • Fax: 417-356-8078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OSAMEDE EDOKPOLO
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 313-506-3036