Provider Demographics
NPI:1386787950
Name:KIMURI, LARISA ELAINE (MD)
Entity type:Individual
Prefix:
First Name:LARISA
Middle Name:ELAINE
Last Name:KIMURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 BILTMORE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4271
Mailing Address - Country:US
Mailing Address - Phone:785-331-1700
Mailing Address - Fax:785-331-1799
Practice Address - Street 1:1220 BILTMORE DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4271
Practice Address - Country:US
Practice Address - Phone:785-505-2626
Practice Address - Fax:785-505-5333
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO206018068207Q00000X
KS04-33260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200572220AMedicaid