Individual
HEIDI D. LARISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2230 N RIDGE RD, WICHITA, KS 67205-1053
(316) 448-8339
Mailing address
2230 N RIDGE RD, WICHITA, KS 67205-1053
(316) 448-8339
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
05-33442
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003719184
MEDICARE
—
05
—
200658020B
—
KS
Enumeration date
06/18/2007
Last updated
01/25/2021
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