Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 01062967A | IN |
NPI | 1043415706 |
---|---|
Provider Name | Dr. Yu Liu |
First Address | Detroit, MI 48278-1076 |
Second Address | Crown Point, IN 46307-8481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 23/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000906995 | BCBS (01) | IN |
200938860 | (05) | IN |
P01539401 | RR MEDICARE SBN (01) | IN |