Provider Demographics
NPI:1225000862
Name:TOLLEFSON, DENISE D (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:D
Last Name:TOLLEFSON
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 1:1500 SW 10TH AVE.
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1353
Mailing Address - Country:US
Mailing Address - Phone:788-535-4524
Mailing Address - Fax:785-354-6349
Practice Address - Street 1:1500 SW 10TH AVE.
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1353
Practice Address - Country:US
Practice Address - Phone:788-535-4524
Practice Address - Fax:785-354-6349
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300830207Q00000X
KS04-39634208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1449572OtherUHC
KS201150440AMedicaid
NC3134236OtherCIGNA
NC83678OtherBCBS
NC3134236OtherCIGNA
NCF88259Medicare UPIN
NC1449572OtherUHC