Healthcare Provider Details

I. General information

NPI: 1992478788
Provider Name (Legal Business Name): MARYAM ESSAM ABDO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CAMBRIDGE ST
KANSAS CITY KS
66160-8501
US

IV. Provider business mailing address

7510 W 136TH PL
OVERLAND PARK KS
66223-3813
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1227
  • Fax:
Mailing address:
  • Phone: 913-548-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number04-52988
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number04-52988
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2025008575
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number2025008575
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: