Provider Demographics
NPI:1356348270
Name:LIAO, THOMAS EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EUGENE
Last Name:LIAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5600 W ADDISON ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4401
Mailing Address - Country:US
Mailing Address - Phone:773-481-1570
Mailing Address - Fax:773-481-0547
Practice Address - Street 1:5600 W ADDISON ST
Practice Address - Street 2:STE 304
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4468
Practice Address - Country:US
Practice Address - Phone:773-481-1570
Practice Address - Fax:773-481-0547
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036064623207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064623Medicaid
IL036064623Medicaid
ILL37065Medicare ID - Type Unspecified