Provider Demographics
NPI:1982645792
Name:KALLSEN, JEFFREY D (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:KALLSEN
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 1:12541 FOSTER ST STE 240
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2301
Mailing Address - Country:US
Mailing Address - Phone:913-317-3170
Mailing Address - Fax:913-317-3193
Practice Address - Street 1:12541 FOSTER ST STE 240
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2301
Practice Address - Country:US
Practice Address - Phone:913-317-3170
Practice Address - Fax:913-317-3193
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116539207RE0101X
KS0427690207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100319190AMedicaid
MO203780622Medicaid