Provider Demographics
NPI:1992478788
Name:ABDO, MARYAM ESSAM
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:ESSAM
Last Name:ABDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 W 136TH PL
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3813
Mailing Address - Country:US
Mailing Address - Phone:913-548-9172
Mailing Address - Fax:
Practice Address - Street 1:7510 W 136TH PL
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-3813
Practice Address - Country:US
Practice Address - Phone:913-548-9172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program