Individual
MR. KEVIN JAY LIUDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2800 PIERCE ST, STE 101, SIOUX CITY, IA 51104
(712) 224-8677
(712) 277-1662
Mailing address
2730 PIERCE ST, STE 300, SIOUX CITY, IA 51104-3765
(712) 224-8677
(712) 277-1662
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
25978
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00784447
MEDICARE RR
IA
Enumeration date
09/08/2006
Last updated
02/20/2019
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