Provider Demographics
NPI:1790751576
Name:ILORETA, ALFREDO T (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:T
Last Name:ILORETA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1657
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66601-1657
Mailing Address - Country:US
Mailing Address - Phone:785-295-8108
Mailing Address - Fax:785-231-5991
Practice Address - Street 1:1516 SW 6TH AVE
Practice Address - Street 2:STE 1
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2729
Practice Address - Country:US
Practice Address - Phone:785-232-1005
Practice Address - Fax:785-232-2564
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-03-09
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Provider Licenses
StateLicense IDTaxonomies
KS0418611208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B68259Medicare UPIN