Provider Demographics
NPI:1255434783
Name:LU, LEO (MD FCAP FIAC)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:LU
Suffix:
Gender:M
Credentials:MD FCAP FIAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1211 N SHARTEL AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2400
Mailing Address - Country:US
Mailing Address - Phone:405-235-8008
Mailing Address - Fax:405-239-2403
Practice Address - Street 1:1211 N SHARTEL AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2400
Practice Address - Country:US
Practice Address - Phone:405-235-8008
Practice Address - Fax:405-239-2403
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2015-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101238346207ZC0500X, 207ZP0101X
FLME65063207ZC0500X, 207ZP0101X
OK21011207ZC0500X, 207ZP0101X
CT040770207ZC0500X, 207ZP0101X
NC200501805207ZC0500X, 207ZP0101X
TN40308207ZC0500X, 207ZP0101X
GA057750207ZC0500X, 207ZP0101X
NV12064207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5001736OtherGHI
OKOKA 105438OtherCMS
OKOKA 105438OtherCMS