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NPI Code Detail

MEDICARE: DR. ELLEN ANITA LIU MD

MEDICARE: DR. ELLEN ANITA LIU MD
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
12080N0001XNeonatal-Perinatal Medicine Physician319324-1205UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790784965
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELLEN ANITA LIU MD
Provider Business Mailing Address
First Line : PO BOX 520691
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84152-0691
Country : US
Telephone Number : 801-296-2113
Fax Number : 801-296-1715
Provider Business Practice Location Address
First Line : 1200 E 3900 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84124-1300
Country : US
Telephone Number : 801-268-7111
Fax Number : 801-296-1715
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 11/02/2011

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