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NPI Code Detail

MEDICARE: DR. SANDY LIEU MD

MEDICARE: DR. SANDY LIEU 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
1207P00000XEmergency Medicine Physician24038MS
2207Q00000XFamily Medicine PhysicianA141935CA
3208M00000XHospitalist Physician24038MS
4207Q00000XFamily Medicine Physician24038MS

Other Identifiers

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

General Provider Information

NPI Number : 1952716573
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANDY LIEU MD
Provider Business Mailing Address
First Line : 8613 MS HIGHWAY 12
Second Line :
City : ACKERMAN
State : MS
Zip : 39735-8917
Country : US
Telephone Number : 662-285-4400
Fax Number :
Provider Business Practice Location Address
First Line : 8613 MS HIGHWAY 12
Second Line :
City : ACKERMAN
State : MS
Zip : 39735-8917
Country : US
Telephone Number : 662-285-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2014
Last Update Date : 06/28/2019

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Directions to “ DR. SANDY LIEU MD” Practice Location

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