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 1:506 EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4205
Mailing Address - Country:US
Mailing Address - Phone:502-822-6603
Mailing Address - Fax:502-747-7071
Practice Address - Street 1:506 EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-822-6603
Practice Address - Fax:502-747-7071
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2025-05-13
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
1284492OtherCIGNA PROVIDER ID NUMBER
KY7100463740Medicaid
10595671OtherPRIME HEALTH SERVICES PROVIDER ID NUMBER
5347788OtherUNITED HEALTHCARE PROVIDER ID NUMBER
KYPDZ000000033943OtherAETNA BETTER HEALTH OF KY PROVIDER ID NUMBER
172422OtherSIHO PROVIDER ID NUMBER
IN300026222Medicaid
000001281272OtherANTHEM PROVIDER ID NUMBER
KY1876096OtherWELLCARE OF KENTUCKY PROVIDER ID NUMBER
5019804OtherAETNA PROVIDER ID NUMBER
CS1923300101OtherCARESOURCE PROVIDER ID NUMBER