Provider Demographics
NPI:1053606103
Name:CONLIFFE, KATHRINE (DO)
Entity type:Individual
Prefix:
First Name:KATHRINE
Middle Name:
Last Name:CONLIFFE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHRINE
Other - Middle Name:
Other - Last Name:KRANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4010 DUPONT CIR STE 283
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4847
Practice Address - Country:US
Practice Address - Phone:502-897-1727
Practice Address - Fax:502-895-0827
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03688208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100317450Medicaid
KY50077825OtherPASSPORT-NCMA
KY000000900606OtherANTHEM-NCMA
KY7100317450Medicaid
KY000000900606OtherANTHEM-NCMA