Provider Demographics
NPI:1790927549
Name:LIEURANCE, TIFFANY LISA (DO)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:LISA
Last Name:LIEURANCE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N CARRIAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4508
Mailing Address - Country:US
Mailing Address - Phone:316-858-5800
Mailing Address - Fax:316-858-5868
Practice Address - Street 1:800 N CARRIAGE PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4508
Practice Address - Country:US
Practice Address - Phone:316-858-5800
Practice Address - Fax:316-858-5868
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006016929207Q00000X
KS0533813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200612410AMedicaid
110664002Medicare PIN