Provider Demographics
NPI:1144258443
Name:LAIS, RANDALL (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:LAIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9828 E SHANNON WOODS CIR # 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4100
Mailing Address - Country:US
Mailing Address - Phone:316-631-1600
Mailing Address - Fax:316-631-1639
Practice Address - Street 1:9828 E SHANNON WOODS CIR # 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4100
Practice Address - Country:US
Practice Address - Phone:316-631-1600
Practice Address - Fax:316-631-1639
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27074207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100199000AMedicaid
KS110705040OtherMEDICARE
TX8BR084OtherBCBS
KS1144258443OtherBCBS
TX041674507Medicaid
TX8S4335OtherBCBS
KS100290930AMedicaid
CO9000171587Medicaid
TX047164506Medicaid