Provider Demographics
NPI:1447488812
Name:FOSS, KALLIE MARIE (MD)
Entity type:Individual
Prefix:
First Name:KALLIE
Middle Name:MARIE
Last Name:FOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KALLIE
Other - Middle Name:MARIE
Other - Last Name:BECHTOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20930 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7228
Mailing Address - Country:US
Mailing Address - Phone:913-782-2525
Mailing Address - Fax:913-782-3907
Practice Address - Street 1:20930 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7228
Practice Address - Country:US
Practice Address - Phone:913-782-2525
Practice Address - Fax:913-782-3907
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-35902208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200968340BMedicaid
KS200968340BMedicaid