MEDICARE: LUISA EDITH TODD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	7152617	UT

General Provider Information

NPI Number	:	1366694812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUISA EDITH TODD M.D.

Provider Business Mailing Address
First Line	:	1017 E 600 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-3828
Country	:	US
Telephone Number	:	801-879-1002
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 E 600 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-3828
Country	:	US
Telephone Number	:	801-879-1002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	10/15/2008

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