Provider Demographics
NPI:1619182052
Name:HARLAN, CHRISTOPHER GEORGE (DO)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:GEORGE
Last Name:HARLAN
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 1:10161 N AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-1366
Mailing Address - Country:US
Mailing Address - Phone:816-691-3091
Mailing Address - Fax:816-346-7014
Practice Address - Street 1:10161 N AMBASSADOR DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-1366
Practice Address - Country:US
Practice Address - Phone:816-691-3091
Practice Address - Fax:816-346-7014
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009012455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00885411OtherRRMEDICARE
MOK67000021Medicare PIN