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NPI Code Detail

MEDICARE: DR. LISA G. DISTEFANO M.D.

MEDICARE: DR. LISA G. DISTEFANO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician119536MO
2208000000XPediatrics Physician119536MO
3207R00000XInternal Medicine Physician0450138KS

General Provider Information

NPI Number : 1003810789
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA G. DISTEFANO M.D.
Provider Business Mailing Address
First Line : 12541 FOSTER ST STE 300
Second Line :
City : OVERLAND PARK
State : KS
Zip : 66213-2304
Country : US
Telephone Number : 913-317-3200
Fax Number : 913-317-3218
Provider Business Practice Location Address
First Line : 12541 FOSTER ST STE 300
Second Line :
City : OVERLAND PARK
State : KS
Zip : 66213-2304
Country : US
Telephone Number : 913-317-3200
Fax Number : 913-317-3218
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 11/12/2024

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