Provider Demographics
NPI:1821021866
Name:ROLSTON, RICHARD DAVID (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DAVID
Last Name:ROLSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4061 INDIAN CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-4030
Mailing Address - Country:US
Mailing Address - Phone:913-323-4600
Mailing Address - Fax:913-323-4748
Practice Address - Street 1:4061 INDIAN CREEK PKWY
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207
Practice Address - Country:US
Practice Address - Phone:913-323-4600
Practice Address - Fax:913-323-4748
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48853208000000X
KS04-41456208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34826100Medicaid
WI34826100Medicaid
ILIL2868005Medicare PIN