Individual
LISA A CLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3901 RAINBOW BOULEVARD, 6067 DELP, MAIL STOP 1028, KANSAS CITY, KS 66160
(913) 588-6035
(913) 945-6916
Mailing address
3901 RAINBOW BOULEVARD, 6067 DELP, MAIL STOP 1028, KANSAS CITY, KS 66160
(913) 588-6035
(913) 945-6916
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
04-25575
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200309880A
—
KS
05
—
207287400
—
MO
01
—
35034016
BCBS KC
MO
01
—
926001
FIRSTGUARD
KS
Enumeration date
09/06/2006
Last updated
05/08/2014
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