MEDICARE: MINI R ABRAHAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	04-30134	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023002565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINI R ABRAHAM M.D.

Provider Business Mailing Address
First Line	:	10550 QUIVIRA RD
Second Line	:	SUITE 530
City	:	OVERLAND PARK
State	:	KS
Zip	:	66215-2306
Country	:	US
Telephone Number	:	913-599-3828
Fax Number	:	913-599-3451

Provider Business Practice Location Address
First Line	:	10000 COLLEGE BLVD
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66210-1435
Country	:	US
Telephone Number	:	913-258-5055
Fax Number	:	913-258-5057

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	06/10/2021

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Directions to “ MINI R ABRAHAM M.D.” Practice Location

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