Healthcare Provider Details

I. General information

NPI: 1689840282
Provider Name (Legal Business Name): TAREK IHSAN ABU-RAJAB TAMIMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2008
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOLMES ST
KANSAS CITY MO
64108-2640
US

IV. Provider business mailing address

2310 HOLMES ST STE 800
KANSAS CITY MO
64108-2602
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-3995
  • Fax: 816-404-3997
Mailing address:
  • Phone: 816-404-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2013014917
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: