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General NPI Number Information
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NPI Number | 1003810789
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Entity Type | Individual
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Provider Name | LISA G. DISTEFANO M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 12541 FOSTER ST STE 300
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City | OVERLAND PARK
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State | KS
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Zip | 66213-2304
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Country | US
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Telephone | 913-317-3200
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Fax | 913-317-3218
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Provider Business Mailing Address
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Address Line | 12541 FOSTER ST STE 300
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City | OVERLAND PARK
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State | KS
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Zip | 66213-2304
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Country | US
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Telephone | 913-317-3200
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Fax | 913-317-3218
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 119536
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 119536
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0450138
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License Number State | KS
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