Provider Demographics
NPI:1851384309
Name:TAYIEM, ABDEL K (MD)
Entity Type:Individual
Prefix:
First Name:ABDEL
Middle Name:K
Last Name:TAYIEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:A
Other - Middle Name:K
Other - Last Name:TAYIEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:625 COMMERCIAL
Mailing Address - Street 2:STE. 7
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002
Mailing Address - Country:US
Mailing Address - Phone:913-367-3900
Mailing Address - Fax:913-367-3904
Practice Address - Street 1:625 COMMERCIAL
Practice Address - Street 2:STE 7
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002
Practice Address - Country:US
Practice Address - Phone:913-367-3900
Practice Address - Fax:913-367-3904
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-15418208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100082110 CMedicaid
10898OtherCOVENTRY HEALTH CARE
4583740OtherAETNA
136352OtherHEALTHLINK
KS100082110 BMedicaid
1417220534OtherGROUP NPI
08677011OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY
1700416OtherUNITED HEALTH CARE
002603OtherBLUE CROSS BLUE SHIELD OF KANSAS
MO200650307OtherMEDICAID OF MISSOURI
3742OtherPREFERRED HEALTH SYTEMS
020009556OtherPALMETTO GBA -RAILROAD MEDICARE
002603OtherBLUE CROSS BLUE SHIELD OF KANSAS
3742OtherPREFERRED HEALTH SYTEMS
4583740OtherAETNA
10898OtherCOVENTRY HEALTH CARE
KSB96008Medicare UPIN