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NPI Code Detail

MEDICARE: DR. LIAUTAUD PROPHETE DO

MEDICARE: DR. LIAUTAUD PROPHETE DO
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
1390200000XStudent in an Organized Health Care Education/Training ProgramPA

General Provider Information

NPI Number : 1649112715
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LIAUTAUD PROPHETE DO
Provider Business Mailing Address
First Line : 2601 HOLME AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19152-2096
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2601 HOLME AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19152-2096
Country : US
Telephone Number : 215-335-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2026
Last Update Date : 04/08/2026

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Directions to “ DR. LIAUTAUD PROPHETE DO” Practice Location

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