Individual
DR. LISA MARIE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4313 STATE AVE, KANSAS CITY, KS 66102-3734
(913) 233-4400
(913) 287-0132
Mailing address
2401 GILLHAM RD, PROVIDER ENROLLMENT, KANSAS CITY, MO 64108-4619
(816) 701-5200
(816) 302-9939
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
04-35777
KS
208000000X
Pediatrics Physician
2007013995
MO
Other
Enumeration date
04/08/2008
Last updated
02/15/2016
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