Provider Demographics
NPI:1003808320
Name:MADSEN, LISA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:MADSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23351 PRAIRIE STAR PKWY
Mailing Address - Street 2:SUITE A245
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66227-6201
Mailing Address - Country:US
Mailing Address - Phone:913-676-8630
Mailing Address - Fax:913-676-8635
Practice Address - Street 1:23351 PRAIRIE STAR PKWY
Practice Address - Street 2:SUITE A245
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227-6201
Practice Address - Country:US
Practice Address - Phone:913-676-8630
Practice Address - Fax:913-676-8635
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0227370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO31640017OtherBCBS KC
102585OtherBC KS
KS2087636301Medicaid
102585OtherBC KS
H74318Medicare UPIN