Healthcare Provider Details

I. General information

NPI: 1205198231
Provider Name (Legal Business Name): AIMEE NICOLE EIDSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AIMEE NICOLE ROBINSON

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 W 119TH ST SUITE 220
OVERLAND PARK KS
66209-3721
US

IV. Provider business mailing address

5701 W 119TH ST SUITE 220
OVERLAND PARK KS
66209-3721
US

V. Phone/Fax

Practice location:
  • Phone: 913-498-8787
  • Fax: 913-498-1744
Mailing address:
  • Phone: 913-498-8787
  • Fax: 913-498-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number05-38099
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2015021663
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: