Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 0227370 | KS |
Y | 111NI0900X | Internist | 0227370 | KS |
NPI | 1003808320 |
---|---|
Provider Name | Lisa Marie Madsen |
First Address | Lenexa, KS 66227-6201 |
Second Address | Lenexa, KS 66227-6201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 30/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102585 | BC KS (01) | |
2087636301 | (05) | KS |
31640017 | BCBS KC (01) | MO |
H74318 | (02) |