Healthcare Provider Details

I. General information

NPI: 1538681903
Provider Name (Legal Business Name): ABDALLAH OMAR AMIREH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 N RIVERSIDE RD STE 150
SAINT JOSEPH MO
64507-2508
US

IV. Provider business mailing address

802 N RIVERSIDE RD STE 150
SAINT JOSEPH MO
64507-2508
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-4025
  • Fax: 816-271-4026
Mailing address:
  • Phone: 816-271-4025
  • Fax: 816-271-4026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number2023032613
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number2023032613
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number2023032613
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2023032613
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: