Provider Demographics
NPI:1861498552
Name:LIVERA, HAROLD J (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:J
Last Name:LIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:217 BRECKENRIDGE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3858
Practice Address - Country:US
Practice Address - Phone:502-895-9421
Practice Address - Fax:502-899-5762
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY25408208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000777754OtherANTHEM - KCMA
KY50039819OtherPASSPORT - KCMA
KY137158OtherSIHO - KCMA
KY64254089Medicaid