Provider Demographics
NPI:1073664603
Name:ANDERSON, CRAIG A (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20375 W 151ST ST
Mailing Address - Street 2:SUITE 463
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7218
Mailing Address - Country:US
Mailing Address - Phone:913-782-8577
Mailing Address - Fax:913-782-2616
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 463
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7218
Practice Address - Country:US
Practice Address - Phone:913-782-8577
Practice Address - Fax:913-782-2616
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0423072208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100118910BMedicaid
E81840Medicare UPIN
KS100118910BMedicaid
020020156OtherRAILROAD MEDICARE
0423072OtherTRICARE
E81840Medicare UPIN
KS100118910AMedicaid