Provider Demographics
NPI:1447087424
Name:MAKUNDI, BONIFACE
Entity type:Individual
Prefix:
First Name:BONIFACE
Middle Name:
Last Name:MAKUNDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15528 FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2889
Mailing Address - Country:US
Mailing Address - Phone:913-263-1443
Mailing Address - Fax:
Practice Address - Street 1:15528 FOSTER ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2889
Practice Address - Country:US
Practice Address - Phone:913-263-1443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSK02-13-1553172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver