Provider Demographics
NPI:1790867521
Name:GAO, LIZHU (MD)
Entity Type:Individual
Prefix:
First Name:LIZHU
Middle Name:
Last Name:GAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12632 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1428
Mailing Address - Country:US
Mailing Address - Phone:708-587-0000
Mailing Address - Fax:708-623-7628
Practice Address - Street 1:12632 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1428
Practice Address - Country:US
Practice Address - Phone:708-587-0000
Practice Address - Fax:708-623-7628
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089167207R00000X
NY240207207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301089167OtherMEDICAL LICENSE
AZZ140417Medicare PIN