Healthcare Provider Details

I. General information

NPI: 1023002565
Provider Name (Legal Business Name): MINI R ABRAHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 COLLEGE BLVD
OVERLAND PARK KS
66210-1435
US

IV. Provider business mailing address

10550 QUIVIRA RD SUITE 530
OVERLAND PARK KS
66215-2306
US

V. Phone/Fax

Practice location:
  • Phone: 913-258-5055
  • Fax: 913-258-5057
Mailing address:
  • Phone: 913-599-3828
  • Fax: 913-599-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number04-30134
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: