Provider Demographics
NPI:1275546947
Name:LUTHY, SIU PING (MD)
Entity Type:Individual
Prefix:DR
First Name:SIU PING
Middle Name:
Last Name:LUTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SIU PING
Other - Middle Name:
Other - Last Name:LOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:411 N MCCROSKEY ST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9330
Practice Address - Country:US
Practice Address - Phone:417-269-2227
Practice Address - Fax:417-269-2235
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003014085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
198376OtherBLUE CROSS
MO207309808Medicaid
P00406088Medicare PIN
MO207309808Medicaid
904545153Medicare PIN
207050038Medicare PIN
904541328Medicare PIN
P00259342Medicare PIN