Provider Demographics
NPI:1467676106
Name:CARLSON, KRISTOPHER RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:RICHARD
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 SW FAIRLAWN RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66610-9420
Mailing Address - Country:US
Mailing Address - Phone:706-373-8095
Mailing Address - Fax:
Practice Address - Street 1:5450 SW FAIRLAWN RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66610-9420
Practice Address - Country:US
Practice Address - Phone:706-373-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-36441208800000X
MN53866208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002217OtherMEDICARE
KS201073240AMedicaid
MN340001240Medicare PIN