Provider Demographics
NPI:1770089005
Name:LISKUTIN, TOMAS E (MD)
Entity type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:E
Last Name:LISKUTIN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:5316 S WOODROW ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5479
Mailing Address - Country:US
Mailing Address - Phone:801-747-1020
Mailing Address - Fax:801-747-1023
Practice Address - Street 1:5316 S WOODROW ST STE 200
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5479
Practice Address - Country:US
Practice Address - Phone:801-747-1020
Practice Address - Fax:801-747-1023
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT13901333-1205207XX0801X
MO2023006696207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200124796Medicaid