Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 03729 | KY |
NPI | 1417243999 |
---|---|
Provider Name | Mark Conliffe |
First Address | Louisville, KY 40207-4202 |
Second Address | Louisville, KY 40207-4202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2011 |
Last Update Date | 11/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000001281272 | ANTHEM PROVIDER ID NUMBER (01) | |
10595671 | PRIME HEALTH SERVICES PROVIDER ID NUMBER (01) | |
1284492 | CIGNA PROVIDER ID NUMBER (01) | |
172422 | SIHO PROVIDER ID NUMBER (01) | |
1876096 | WELLCARE OF KENTUCKY PROVIDER ID NUMBER (01) | KY |
300026222 | (05) | IN |
5019804 | AETNA PROVIDER ID NUMBER (01) | |
5347788 | UNITED HEALTHCARE PROVIDER ID NUMBER (01) | |
7100463740 | (05) | KY |
CS1923300101 | CARESOURCE PROVIDER ID NUMBER (01) | |
PDZ000000033943 | AETNA BETTER HEALTH OF KY PROVIDER ID NUMBER (01) | KY |