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General NPI Number Information
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NPI Number | 1295099075
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Entity Type | Individual
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Provider Name | ADAM ALEXANDER LIUDAHL M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 200 HAWKINS DR DEPARTMENT OF RADIOLOGY
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City | IOWA CITY
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State | IA
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Zip | 96813-2409
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Country | US
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Telephone | 319-356-3396
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Fax |
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Provider Business Mailing Address
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Address Line | 1356 LUSITANA ST 6TH FLOOR
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City | HONOLULU
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State | HI
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Zip | 96813-2409
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Country | US
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Telephone | 808-586-2920
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD-44350
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | MDR-6341
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License Number State | HI
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