Provider Demographics
NPI:1497932032
Name:UNRUH, LISA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:UNRUH
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 1:114 N LEHMBERG RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-5554
Mailing Address - Country:US
Mailing Address - Phone:662-329-2955
Mailing Address - Fax:662-370-1236
Practice Address - Street 1:550 N HILLSIDE ST
Practice Address - Street 2:BUILDING 1, 6TH FLOOR
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4910
Practice Address - Country:US
Practice Address - Phone:316-962-7422
Practice Address - Fax:316-962-7805
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-33838208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0433838OtherMEDICAL LICENSE