Provider Demographics
NPI:1306985064
Name:RICHARD DOUGLAS ILIFF MD PA
Entity type:Organization
Organization Name:RICHARD DOUGLAS ILIFF MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:ILIFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-271-6161
Mailing Address - Street 1:1119 SW GAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1999
Mailing Address - Country:US
Mailing Address - Phone:785-271-6161
Mailing Address - Fax:785-271-6414
Practice Address - Street 1:1119 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1999
Practice Address - Country:US
Practice Address - Phone:785-271-6161
Practice Address - Fax:785-271-6414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS0418610207Q00000X
KSKS1500243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB69189Medicare UPIN