Provider Demographics
NPI:1003174814
Name:SCHMIDT, ALISA L (MD)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:L
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3515 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4921
Mailing Address - Country:US
Mailing Address - Phone:316-755-0144
Mailing Address - Fax:844-274-1204
Practice Address - Street 1:3515 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4921
Practice Address - Country:US
Practice Address - Phone:316-755-0144
Practice Address - Fax:844-274-1204
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-36789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201110460BMedicaid
KS04-36789OtherKANSAS LICENSE