MEDICARE: LYNN R FISHER 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
1	207Q00000X	Family Medicine Physician	04-30818	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	105275	OTHER	KS	BC/BS INDIVIDUAL
2	111215	OTHER	KS	BC/BS GROUP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	460593	OTHER	KS	CHILDREN'S MERCY FAMILY H

General Provider Information

NPI Number	:	1083615447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN R FISHER M.D.

Provider Business Mailing Address
First Line	:	1010 N KANSAS ST STE 3001D
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67214-3124
Country	:	US
Telephone Number	:	316-293-2607
Fax Number	:	316-293-2696

Provider Business Practice Location Address
First Line	:	1010 N KANSAS ST STE 3001D
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67214-3124
Country	:	US
Telephone Number	:	316-293-2607
Fax Number	:	316-293-2696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	01/27/2022

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