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 1:1150 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2805
Mailing Address - Country:US
Mailing Address - Phone:316-866-2065
Mailing Address - Fax:
Practice Address - Street 1:1400 SW HUNTOON ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1231
Practice Address - Country:US
Practice Address - Phone:785-861-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-39634207Q00000X
NC9300830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1449572OtherUHC
KS201150440AMedicaid
NC3134236OtherCIGNA
NC83678OtherBCBS
NC3134236OtherCIGNA
NCF88259Medicare UPIN
NC1449572OtherUHC