MEDICARE: DR. KEVIN LIU M.D.

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	K7801	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	89078G	OTHER	TX	BCBS
2	00N59X	OTHER	TX	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8K4021	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1437167046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN LIU M.D.

Provider Business Mailing Address
First Line	:	601 S MAIN ST
Second Line	:	SUITE 200
City	:	KELLER
State	:	TX
Zip	:	76248-7029
Country	:	US
Telephone Number	:	817-753-6888
Fax Number	:	817-753-6885

Provider Business Practice Location Address
First Line	:	601 S MAIN ST
Second Line	:	SUITE 200
City	:	KELLER
State	:	TX
Zip	:	76248-7029
Country	:	US
Telephone Number	:	817-753-6888
Fax Number	:	817-753-6885

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	03/16/2023

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Directions to “ DR. KEVIN LIU M.D.” Practice Location

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