Provider Demographics
NPI:1578555975
Name:OLSON, KEVIN RONALD (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:RONALD
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8550 MARSHALL DR STE 220
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1505
Mailing Address - Country:US
Mailing Address - Phone:816-524-3799
Mailing Address - Fax:913-495-3727
Practice Address - Street 1:615 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2212
Practice Address - Country:US
Practice Address - Phone:816-524-3799
Practice Address - Fax:913-495-3727
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003014706207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208414805Medicaid
MOP01023732OtherRR MEDICARE MO
008D005Medicare ID - Type Unspecified
MOK67000032Medicare PIN
MO208414805Medicaid