Provider Demographics
NPI:1780786095
Name:VANSAGHI, LISA M (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:VANSAGHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6700 W 115TH ST
Mailing Address - Street 2:#3519
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1553
Mailing Address - Country:US
Mailing Address - Phone:913-708-6144
Mailing Address - Fax:913-708-7607
Practice Address - Street 1:6700 W 115TH ST
Practice Address - Street 2:#3519
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1553
Practice Address - Country:US
Practice Address - Phone:913-708-6144
Practice Address - Fax:913-708-7607
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30109207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO32856011OtherBCBS KC
KS100454310AMedicaid
MO208406306Medicaid
H81407Medicare UPIN
MO32856011OtherBCBS KC
MO208406306Medicaid