Provider Demographics
NPI:1427026228
Name:PETERSEN, HILARY A (MD)
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:A
Last Name:PETERSEN
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:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66201-0838
Mailing Address - Country:US
Mailing Address - Phone:913-469-4244
Mailing Address - Fax:913-469-1939
Practice Address - Street 1:10500 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2306
Practice Address - Country:US
Practice Address - Phone:913-541-5340
Practice Address - Fax:913-541-5032
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS430458207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS33554071OtherBCBS OF KCMO GROUP 01674018
KS200254670JMedicaid
KS200254670KMedicaid
KS33554081OtherBCBS OF KCMO GROUP 30492021
KSP00666161OtherRR MEDICARE GROUP CG8899
KSP00763781OtherRR MEDICARE GROUP DC6712
KSP00666161OtherRR MEDICARE GROUP CG8899
KSR97000004Medicare PIN
KS33554071OtherBCBS OF KCMO GROUP 01674018