Provider Demographics
NPI:1215921853
Name:SCHNICK, LISA A (DO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:SCHNICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 W 119TH ST
Mailing Address - Street 2:SUITE 135
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3722
Mailing Address - Country:US
Mailing Address - Phone:913-451-1311
Mailing Address - Fax:913-451-7511
Practice Address - Street 1:5701 W 119TH ST
Practice Address - Street 2:SUITE 135
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3722
Practice Address - Country:US
Practice Address - Phone:913-451-1311
Practice Address - Fax:913-451-7511
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS30899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2002685301AMedicaid
I19066Medicare UPIN
KS2002685301AMedicaid
KSP08D384Medicare PIN