Provider Demographics
NPI:1679922652
Name:LISENBY, COLIN B (MD)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:B
Last Name:LISENBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4722 W KELLOGG DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2508
Mailing Address - Country:US
Mailing Address - Phone:316-440-2565
Mailing Address - Fax:316-440-2750
Practice Address - Street 1:4722 W KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2508
Practice Address - Country:US
Practice Address - Phone:316-440-2565
Practice Address - Fax:316-440-2750
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-41606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine