Provider Demographics
NPI:1306899497
Name:RILEY, DAVID MARK (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARK
Last Name:RILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 W 135TH
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221
Mailing Address - Country:US
Mailing Address - Phone:913-851-9800
Mailing Address - Fax:913-851-9888
Practice Address - Street 1:8708 W 135TH
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221
Practice Address - Country:US
Practice Address - Phone:913-851-9800
Practice Address - Fax:913-851-9888
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0423279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100145066AMedicaid
KS0333036DMedicare PIN
KS100145066AMedicaid