Provider Demographics
NPI:1417243999
Name:CONLIFFE, MARK (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CONLIFFE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:225 EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4202
Practice Address - Country:US
Practice Address - Phone:502-855-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03729204D00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
5347788OtherUNITED HEALTHCARE PROVIDER ID NUMBER
KYPDZ000000033943OtherAETNA BETTER HEALTH OF KY PROVIDER ID NUMBER
000001281272OtherANTHEM PROVIDER ID NUMBER
172422OtherSIHO PROVIDER ID NUMBER
5019804OtherAETNA PROVIDER ID NUMBER
10595671OtherPRIME HEALTH SERVICES PROVIDER ID NUMBER
KY1876096OtherWELLCARE OF KENTUCKY PROVIDER ID NUMBER
IN300026222Medicaid
KY7100463740Medicaid
CS1923300101OtherCARESOURCE PROVIDER ID NUMBER
1284492OtherCIGNA PROVIDER ID NUMBER