Provider Demographics
NPI:1053609107
Name:CARLSON, ANJALEE GOEL (DO)
Entity type:Individual
Prefix:
First Name:ANJALEE
Middle Name:GOEL
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20375 W 151ST ST STE 251
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7253
Mailing Address - Country:US
Mailing Address - Phone:913-393-4888
Mailing Address - Fax:913-764-6884
Practice Address - Street 1:2090 W DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-6869
Practice Address - Country:US
Practice Address - Phone:913-356-8300
Practice Address - Fax:913-356-8711
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7775207R00000X
CODR0055875207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS033D00198OtherMEDICARE WPS
KS201095770DMedicaid