Provider Demographics
NPI:1831184902
Name:FISHER, LAURIE D (MD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:D
Last Name:FISHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13725 METCALF AVE # 403
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-7899
Mailing Address - Country:US
Mailing Address - Phone:913-498-8787
Mailing Address - Fax:913-498-1744
Practice Address - Street 1:13725 METCALF AVE # 403
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-7899
Practice Address - Country:US
Practice Address - Phone:913-498-8787
Practice Address - Fax:913-498-1744
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD 103975207Q00000X
KS04-26270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100192310CMedicaid
MO208278135Medicaid
KSF88697Medicare UPIN
KSP039352Medicare ID - Type Unspecified