Basic Information
| Provider Information | |||||||||
| NPI: | 1821098641 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LU | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1289 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336011289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138447000 | ||||||||
| FaxNumber: | 8138441655 | ||||||||
| Practice Location | |||||||||
| Address1: | 409 BAYSHORE BLVD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138445544 | ||||||||
| FaxNumber: | 8138441655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 11/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | 201318 | NY | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 204F00000X | 32328 | DC | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 204F00000X | 036127059 | IL | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | 036127059 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 204F00000X | ME134625 | FL | Y | Allopathic & Osteopathic Physicians | Transplant Surgery |
No ID Information.