Provider Demographics
NPI:1063494664
Name:OLSON, PETER H (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:H
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 HICKMAN MILLS DR
Mailing Address - Street 2:100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-1674
Mailing Address - Country:US
Mailing Address - Phone:816-763-5446
Mailing Address - Fax:816-763-8526
Practice Address - Street 1:6601 ROCKHILL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1118
Practice Address - Country:US
Practice Address - Phone:816-763-5446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005015838207L00000X
KS04-31554207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO013D919Medicare ID - Type Unspecified
MOH29506Medicare UPIN