Provider Demographics
NPI:1073549820
Name:LISTERMAN, JOHN (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:LISTERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1 RIVERFRONT PLZ
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2293
Mailing Address - Country:US
Mailing Address - Phone:785-841-7297
Mailing Address - Fax:785-856-0375
Practice Address - Street 1:1 RIVERFRONT PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2293
Practice Address - Country:US
Practice Address - Phone:785-841-7297
Practice Address - Fax:785-856-0375
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS420040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100117670BMedicaid
B68976Medicare UPIN
KS100117670BMedicaid