Basic Information
| Provider Information | |||||||||
| NPI: | 1497932032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UNRUH | ||||||||
| FirstName: | LISA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 N LEHMBERG RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397025554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623292955 | ||||||||
| FaxNumber: | 6623701236 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 N HILLSIDE ST | ||||||||
| Address2: | BUILDING 1, 6TH FLOOR | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672144910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3169627422 | ||||||||
| FaxNumber: | 3169627805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2008 | ||||||||
| LastUpdateDate: | 04/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 04-33838 | KS | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.