Provider Demographics
NPI:1003818345
Name:HERMES, LISA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:HERMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4401 WORNALL RD
Mailing Address - Street 2:REHAB PHYSICIANS MEDICAL GROUP, MAIN 4
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3220
Mailing Address - Country:US
Mailing Address - Phone:816-932-2020
Mailing Address - Fax:816-932-6211
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:REHAB PHYSICIANS MEDICAL GROUP, MAIN 4
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:816-932-2020
Practice Address - Fax:816-932-6211
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0429105208100000X
MO2001006202208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205318504Medicaid
KS100404340BMedicaid
KS139B017Medicare PIN
H34634Medicare UPIN
MOJ36B017Medicare PIN
KS101693Medicare PIN
MO205318504Medicaid