Healthcare Provider Details

I. General information

NPI: 1164865077
Provider Name (Legal Business Name): MARIAN MAKRAM GIRGIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4851 HORTON ST
MISSION KS
66202-1758
US

IV. Provider business mailing address

4851 HORTON ST
MISSION KS
66202-1758
US

V. Phone/Fax

Practice location:
  • Phone: 858-775-8197
  • Fax:
Mailing address:
  • Phone: 913-588-6917
  • Fax: 913-588-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94-08194
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: