MEDICARE: INGENUE FAITH COBBINAH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	112413	MO

General Provider Information

NPI Number	:	1558364067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGENUE FAITH COBBINAH M.D.

Provider Business Mailing Address
First Line	:	901 E. 104TH ST.
Second Line	:	MAILSTOP 400N
City	:	LEES SUMMIT
State	:	MO
Zip	:	64131
Country	:	US
Telephone Number	:	816-502-7104
Fax Number	:	816-932-9670

Provider Business Practice Location Address
First Line	:	2737 NE MCBAINE DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-7880
Country	:	US
Telephone Number	:	816-251-5780
Fax Number	:	816-251-5781

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	02/27/2018

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