Healthcare Provider Details

I. General information

NPI: 1467940163
Provider Name (Legal Business Name): ANDREW ABUMOUSSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 NE SAINT LUKES BLVD STE 300
LEES SUMMIT MO
64086-6001
US

IV. Provider business mailing address

20 NE SAINT LUKES BLVD STE 300
LEES SUMMIT MO
64086-6001
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-2700
  • Fax: 816-932-2705
Mailing address:
  • Phone: 816-932-2700
  • Fax: 816-932-2705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number04-51207
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2025011424
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: