Healthcare Provider Details

I. General information

NPI: 1487682092
Provider Name (Legal Business Name): NISREEN ABBAS HAIDERI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NISREEN HAIDERI

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12140 NALL AVE STE 200
OVERLAND PARK KS
66209-2507
US

IV. Provider business mailing address

12140 NALL AVE STE 200
OVERLAND PARK KS
66209-2507
US

V. Phone/Fax

Practice location:
  • Phone: 913-498-7409
  • Fax: 913-498-7470
Mailing address:
  • Phone: 913-498-7409
  • Fax: 913-498-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2004021784
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number04-33380
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2004021784
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number04-33380
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: