Healthcare Provider Details

I. General information

NPI: 1386805430
Provider Name (Legal Business Name): YU LUO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2008
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 CHILDRENS WAY DEPT. RADIOLOGY
NASHVILLE TN
37232-0034
US

IV. Provider business mailing address

3841 GREEN HILLS VILLAGE DR STE 200
NASHVILLE TN
37215-2691
US

V. Phone/Fax

Practice location:
  • Phone: 313-320-0076
  • Fax:
Mailing address:
  • Phone: 615-936-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number47809
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: