Healthcare Provider Details

I. General information

NPI: 1588754196
Provider Name (Legal Business Name): THEODORE GEH-LU LIOU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

PO BOX 413033
SALT LAKE CITY UT
84141-3033
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7806
  • Fax:
Mailing address:
  • Phone: 801-213-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number182794-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number182794-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: