MEDICARE: DR. THOMAS EUGENE LIAO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	036064623	IL
2	207RP1001X	Pulmonary Disease Physician	036064623	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356348270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS EUGENE LIAO M.D.

Provider Business Mailing Address
First Line	:	5600 W ADDISON ST
Second Line	:	SUITE 304
City	:	CHICAGO
State	:	IL
Zip	:	60634-4401
Country	:	US
Telephone Number	:	773-481-1570
Fax Number	:	773-481-0547

Provider Business Practice Location Address
First Line	:	5600 W ADDISON ST
Second Line	:	STE 304
City	:	CHICAGO
State	:	IL
Zip	:	60634-4468
Country	:	US
Telephone Number	:	773-481-1570
Fax Number	:	773-481-0547

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	04/14/2016

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