Provider Demographics
NPI:1821098641
Name:LU, AMY D (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:LU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-844-7000
Mailing Address - Fax:813-844-1655
Practice Address - Street 1:409 BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606
Practice Address - Country:US
Practice Address - Phone:813-844-5544
Practice Address - Fax:813-844-1655
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY201318204F00000X
DC32328204F00000X
IL036127059204F00000X, 208600000X
FLME134625204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H18586Medicare UPIN
DC005462G65Medicare PIN