Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 01077705A | IN |
NPI | 1386634236 |
---|---|
Provider Name | Paul C Liu |
First Address | South Bend, IN 46617-1924 |
Second Address | South Bend, IN 46601-1168 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 30/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201409420 | (05) | IN |
236040230 | MEDICARE PTAN (01) | IN |
261930014 | MEDICARE PTAN (01) | IN |
F86085 | (02) | NY |