Basic Information
| Provider Information | |||||||||
| NPI: | 1386787950 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIMURI | ||||||||
| FirstName: | LARISA | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220 BILTMORE DR | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660494271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853311700 | ||||||||
| FaxNumber: | 7853311799 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220 BILTMORE DR | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660494271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855052626 | ||||||||
| FaxNumber: | 7855055333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 09/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 206018068 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 04-33260 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200572220A | 05 | KS | MEDICAID |