Provider Demographics
NPI:1700049780
Name:FARLEY, LIANNE (MD)
Entity type:Individual
Prefix:
First Name:LIANNE
Middle Name:
Last Name:FARLEY
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 1:1200 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0900
Mailing Address - Country:US
Mailing Address - Phone:605-504-5400
Mailing Address - Fax:605-504-5150
Practice Address - Street 1:1600 S HIGHLINE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-1007
Practice Address - Country:US
Practice Address - Phone:605-504-5600
Practice Address - Fax:605-322-2926
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1667208000000X
IA39031208000000X
SD16829208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1700049780Medicaid
IA1700049780Medicaid