MEDICARE: HEIDI D. LARISON DO

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	05-33442	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	003719184	OTHER		MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447455662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI D. LARISON DO

Provider Business Mailing Address
First Line	:	2230 N RIDGE RD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-1053
Country	:	US
Telephone Number	:	316-448-8339
Fax Number	:

Provider Business Practice Location Address
First Line	:	2230 N RIDGE RD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-1053
Country	:	US
Telephone Number	:	316-448-8339
Fax Number	:

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

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	01/25/2021

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Directions to “ HEIDI D. LARISON DO” Practice Location

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