Provider Demographics
NPI:1093905564
Name:MURPHY, MILDRED LAURA (MD)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:LAURA
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1500 SW 10TH AVE.
Mailing Address - Street 2:PEDIATRIC INTENSIVE CARE UNIT
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604
Mailing Address - Country:US
Mailing Address - Phone:785-354-5242
Mailing Address - Fax:
Practice Address - Street 1:1500 SW 10TH AVE.
Practice Address - Street 2:PEDIATRIC INTENSIVE CARE UNIT
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604
Practice Address - Country:US
Practice Address - Phone:785-354-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-283602080P0203X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100398160CMedicaid
KSKA2129033OtherMEDICARE PTAN
KS100398160EMedicaid
KS100398160EMedicaid