Healthcare Provider Details

I. General information

NPI: 1295099075
Provider Name (Legal Business Name): ADAM ALEXANDER LIUDAHL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR DEPARTMENT OF RADIOLOGY
IOWA CITY IA
96813-2409
US

IV. Provider business mailing address

1356 LUSITANA ST 6TH FLOOR
HONOLULU HI
96813-2409
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-3396
  • Fax:
Mailing address:
  • Phone: 808-586-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD-44350
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMDR-6341
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: