Mithulya Amboo Mahentheran, MD
Individual provider Active NPI Anatomic Pathology & Clinical Pathology Physician · Kansas City, MO
NPI 1912880352 · NPPES record last updated Jul 30, 2025
Key facts
- NPI
- 1912880352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
- License
- 2025027734 (MO)
- Practice address
- 2301 Holmes St
Kansas City, MO 64108-2640 - Phone
- (816) 404-0582
- NPI assigned
- Jul 30, 2025
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250806003284 | MO | Order and Referring Only - Pathology |
2062920341 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 2025027734 | MO | Yes |
Addresses
Primary practice location
2301 Holmes St
Kansas City, MO 64108-2640
Mailing address
2301 Holmes St
Kansas City, MO 64108-2640
Phone (816) 404-0582
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- Allison Kay Ambrose
- Douglas R Ambrose
- Katherine E Ambrosier Groves
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All providers in Kansas City, MO · Anatomic Pathology & Clinical Pathology Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.