Provider Demographics
NPI:1770500795
Name:QUIASON, STELLA G (MD)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:G
Last Name:QUIASON
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 1:20375 W 151ST ST
Mailing Address - Street 2:203
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5306
Mailing Address - Country:US
Mailing Address - Phone:913-393-9898
Mailing Address - Fax:913-393-9893
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:203
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5306
Practice Address - Country:US
Practice Address - Phone:913-393-9898
Practice Address - Fax:913-393-9893
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0429135174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSE65104Medicare UPIN
KS03300009DMedicare PIN