Provider Demographics
NPI:1023002565
Name:ABRAHAM, MINI R (MD)
Entity Type:Individual
Prefix:
First Name:MINI
Middle Name:R
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 QUIVIRA RD
Mailing Address - Street 2:SUITE 530
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2306
Mailing Address - Country:US
Mailing Address - Phone:913-599-3828
Mailing Address - Fax:913-599-3451
Practice Address - Street 1:10000 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1435
Practice Address - Country:US
Practice Address - Phone:913-258-5055
Practice Address - Fax:913-258-5057
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30134207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200608690AMedicaid
MO1023002565Medicaid
KSY20000005Medicare PIN
KSP00724698Medicare PIN
KS200608690AMedicaid