Provider Demographics
NPI:1235233545
Name:IDEMUNDIA-BRYANT, ANN OMOROVBIYE (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:OMOROVBIYE
Last Name:IDEMUNDIA-BRYANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:OMOROVBIYE
Other - Last Name:IDEMUNDIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-701-5200
Mailing Address - Fax:816-302-9939
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3000
Practice Address - Fax:816-302-9939
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NECP134208M00000X
OK38908208M00000X
MO2014039523208000000X
CAC54911208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA321114199AMedicaid
GA373267OtherAETNA
GA589412OtherBCBS - LMAC
GA894211OtherBCBS - EAPC
GA321114199AMedicaid
GA37BBGQSMedicare ID - Type Unspecified