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General NPI Number Information
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NPI Number | 1053636092
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Entity Type | Individual
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Provider Name | EMILY SUZANNE MATHIESEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/01/2010
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 21120 W 152ND ST STE 201
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City | OLATHE
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State | KS
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Zip | 66061
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Country | US
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Telephone | 913-491-4020
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Fax | 913-491-4725
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Provider Business Mailing Address
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Address Line | 9301 W 74TH ST STE 320
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City | OVERLAND PARK
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State | KS
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Zip | 66204-2207
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Country | US
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Telephone | 913-491-4020
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Fax | 913-491-4725
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2014015770
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 04-39438
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License Number State | KS
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