Provider Demographics
NPI:1437787462
Name:MALYAK, LISA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MALYAK
Suffix:
Gender:F
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:UNIVERSITY OF KANSAS ORTHOPEDIC SPORTS MEDICINE
Mailing Address - Street 2:3901 RAINBOW BLVD, MS 3107
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-0575
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF COLORADO SCHOOL OF MEDICINE GME
Practice Address - Street 2:13001 EAST 17TH PLACE
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2581
Practice Address - Country:US
Practice Address - Phone:303-724-8472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS0451323207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program