Provider Demographics
NPI:1417220534
Name:ABDEL KARIM HASAN JABER TAYIEM, M.D., P.A.
Entity type:Organization
Organization Name:ABDEL KARIM HASAN JABER TAYIEM, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDEL
Authorized Official - Middle Name:KARIM HASAN JABER
Authorized Official - Last Name:TAYIEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-367-3900
Mailing Address - Street 1:625 COMMERCIAL ST
Mailing Address - Street 2:STE 7
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-2402
Mailing Address - Country:US
Mailing Address - Phone:913-367-3900
Mailing Address - Fax:913-367-3904
Practice Address - Street 1:625 COMMERCIAL ST
Practice Address - Street 2:STE 7
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-2402
Practice Address - Country:US
Practice Address - Phone:913-367-3900
Practice Address - Fax:913-367-3904
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABDEL KARIM HASASN JABER TAYIEM, M.D., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-21
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
020009556OtherPALMETTO GBA- RAILROAD MEDICARE
08677011OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY
1700416OtherUNITED HEALTHCARE
KS1851384309OtherUNICARE HEALTH PLAN OF KANSAS
KS100082110 CMedicaid
136352OtherHEALTHLINK
263689OtherHUMANA
KS002603OtherMEDICARE PTAN
KS100082110 BMedicaid
1851384309OtherINDIVIDUAL NPI
4583740OtherAETNA
KS462005OtherCHILDRENS MERCY FAMILY HEALTH PARTNERS
10898OtherCOVENTRY HEALTHCARE
MO200650307OtherMEDICAID OF MISSOURI
3742OtherPEFERRED HEALTH SYSTEMS
KS100082110 BMedicaid