Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 04-30134 | KS |
NPI | 1023002565 |
---|---|
Provider Name | Mini R Abraham |
First Address | Overland Park, KS 66215-2306 |
Second Address | Overland Park, KS 66210-1435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 10/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023002565 | (05) | MO |
200608690A | (05) | KS |
H-21088 | (02) | KS |