Provider Demographics
NPI:1407808439
Name:ELIASON, CHRISTINA LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LOUISE
Last Name:ELIASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15710 W 135TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1508
Mailing Address - Country:US
Mailing Address - Phone:913-297-7472
Mailing Address - Fax:
Practice Address - Street 1:15710 W 135TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1508
Practice Address - Country:US
Practice Address - Phone:913-297-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022016885207Q00000X
KS0429444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100428810AMedicaid
H71695Medicare UPIN
KS100428810AMedicaid