MEDICARE: AIWEN LIU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01084174A	IN

General Provider Information

NPI Number	:	1225561798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIWEN LIU MD

Provider Business Mailing Address
First Line	:	909 ELMROW DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-3173
Country	:	US
Telephone Number	:	260-266-0780
Fax Number	:	260-425-4935

Provider Business Practice Location Address
First Line	:	909 ELMROW DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-3173
Country	:	US
Telephone Number	:	260-266-0780
Fax Number	:	260-266-0785

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	01/04/2025

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Directions to “ AIWEN LIU MD” Practice Location

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