Healthcare Provider Details

I. General information

NPI: 1326334459
Provider Name (Legal Business Name): OSAMEDE EDOKPOLO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NMN NMN NMN MD

II. Dates (important events)

Enumeration Date: 06/27/2011
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 Code2084P0800X
TaxonomyPsychiatry Physician
License Number2013002773
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: