Provider Demographics
NPI:1164424339
Name:BELSON, IAN LESLIE (DO)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:LESLIE
Last Name:BELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12140 NALL
Mailing Address - Street 2:SUITE 230
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2503
Mailing Address - Country:US
Mailing Address - Phone:913-661-9434
Mailing Address - Fax:913-661-4688
Practice Address - Street 1:12140 NALL
Practice Address - Street 2:SUITE 230
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2503
Practice Address - Country:US
Practice Address - Phone:913-661-9434
Practice Address - Fax:913-661-4688
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05254742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100179430FMedicaid
MO240870642Medicaid
KSP00425657Medicare PIN
MO240870642Medicaid
E46581Medicare UPIN
KSX333288Medicare PIN