MEDICARE: INSTITUTE FOR LIVER HEALTH, LLC

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	207RI0008X	Hepatology Physician	49951	AZ

General Provider Information

NPI Number	:	1831603505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE FOR LIVER HEALTH, LLC

Provider Business Mailing Address
First Line	:	1727 W. FRYE RD
Second Line	:	STE 9
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5296
Country	:	US
Telephone Number	:	480-470-4000
Fax Number	:	480-686-8875

Provider Business Practice Location Address
First Line	:	2201 W FAIRVIEW ST STE 9
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-4711
Country	:	US
Telephone Number	:	480-470-4000
Fax Number	:	480-686-8875

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ANITA KOHLI
Credential	:	M.D.
Telephone Number	:	480-470-4000

Provider Enumeration Date	:	11/16/2017
Last Update Date	:	06/18/2020

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