MEDICARE: DR. KELLY D KREISLER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0429991	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144287996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY D KREISLER MD

Provider Business Mailing Address
First Line	:	407 S CLAIRBORNE RD
Second Line	:	SUITE 104
City	:	OLATHE
State	:	KS
Zip	:	66062-1857
Country	:	US
Telephone Number	:	913-648-2266
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	MAIL STOP 4004
City	:	KANSAS CITY
State	:	KS
Zip	:	66103-2937
Country	:	US
Telephone Number	:	913-588-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	01/16/2014

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