Healthcare Provider Details

I. General information

NPI: 1043877285
Provider Name (Legal Business Name): JIA LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 E MAYO BLVD
PHOENIX AZ
85054-4502
US

IV. Provider business mailing address

1500 EAST MEDICAL CENTER DRIVE B1-380 TAUBMAN CENTER
ANN ARBOR MI
48109
US

V. Phone/Fax

Practice location:
  • Phone: 626-228-8222
  • Fax:
Mailing address:
  • Phone: 734-763-7919
  • Fax: 734-763-9298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number76462
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301509456
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number76462
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: