MEDICARE: DR. MIRANDA NABIL BISHARA 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	207W00000X	Ophthalmology Physician	2010005177	MO

General Provider Information

NPI Number	:	1437191988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIRANDA NABIL BISHARA M.D.

Provider Business Mailing Address
First Line	:	5520 COLLEGE BLVD
Second Line	:	STE 201
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1658
Country	:	US
Telephone Number	:	913-491-3737
Fax Number	:	913-469-6686

Provider Business Practice Location Address
First Line	:	7400 STATE LINE RD
Second Line	:	SUITE 100
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-3444
Country	:	US
Telephone Number	:	913-588-6600
Fax Number	:	913-588-6655

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

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	05/09/2022

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