Provider Demographics
NPI:1679586366
Name:WAXMAN, LISA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WAXMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2200 SW 6TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1707
Mailing Address - Country:US
Mailing Address - Phone:785-354-8518
Mailing Address - Fax:785-354-1255
Practice Address - Street 1:8919 PARALLEL PKWY STE 380
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1545
Practice Address - Country:US
Practice Address - Phone:913-788-7099
Practice Address - Fax:913-788-7065
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0422304207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100125590CMedicaid
KS110426049Medicare PIN
B57493Medicare UPIN
MO17457072OtherBCBS OF KC
KSF502747Medicare PIN