MEDICARE: DR. NIANSEN 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	2084P0800X	Psychiatry Physician	36406	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4175788	OTHER		BCBS

General Provider Information

NPI Number	:	1679578371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIANSEN LIU M.D.

Provider Business Mailing Address
First Line	:	3555 KEITH ST NW
Second Line	:	STE 102
City	:	CLEVELAND
State	:	TN
Zip	:	37312-4375
Country	:	US
Telephone Number	:	423-728-2282
Fax Number	:	423-728-2234

Provider Business Practice Location Address
First Line	:	3555 KEITH ST NW
Second Line	:	STE 102
City	:	CLEVELAND
State	:	TN
Zip	:	37312-4375
Country	:	US
Telephone Number	:	423-728-2282
Fax Number	:	423-728-2234

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	12/17/2013

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