Provider Demographics
NPI:1225077522
Name:BOYAJIAN-ONEILL, LORI (DO)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:BOYAJIAN-ONEILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13003 WALMER ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3616
Mailing Address - Country:US
Mailing Address - Phone:913-915-9887
Mailing Address - Fax:
Practice Address - Street 1:6500 W 143RD ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2174
Practice Address - Country:US
Practice Address - Phone:913-815-1861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO9N50207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080135930OtherRAILROAD MEDICARE
KS200584170BMedicaid
MO243565322Medicaid
MO080135930OtherRAILROAD MEDICARE
MO1225077522Medicaid
KS200584170AMedicaid
E44530Medicare UPIN
MOP00703585Medicare PIN
MO080135930OtherRAILROAD MEDICARE
2303466Medicare ID - Type Unspecified