Provider Demographics
NPI:1275504011
Name:OLMSTEAD, CALVIN GRANT (MD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:GRANT
Last Name:OLMSTEAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S. MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:316-682-5544
Mailing Address - Fax:316-682-9944
Practice Address - Street 1:3243 E. MURDOCK
Practice Address - Street 2:SUITE 104
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3018
Practice Address - Country:US
Practice Address - Phone:316-682-5544
Practice Address - Fax:316-682-9944
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04204852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100113740CMedicaid
KS100113740AMedicaid
OKKA1853001Medicare PIN
KS100113740CMedicaid
KSB91112Medicare UPIN
OKP00858152Medicare PIN