Healthcare Provider Details

I. General information

NPI: 1477014736
Provider Name (Legal Business Name): LIVER CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 W WARNER RD STE D1
CHANDLER AZ
85225-2945
US

IV. Provider business mailing address

1810 S CRISMON RD STE 191
MESA AZ
85209-3900
US

V. Phone/Fax

Practice location:
  • Phone: 859-393-0575
  • Fax:
Mailing address:
  • Phone: 480-393-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SUDHAKAR A REDDY
Title or Position: PROPRIETOR
Credential: MD
Phone: 480-393-5075