Healthcare Provider Details

I. General information

NPI: 1952539470
Provider Name (Legal Business Name): MARK LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST STE 2508
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

10TH MDG 4102 PINION DR
USAF ACADEMY CO
80840
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-6999
  • Fax: 719-365-2837
Mailing address:
  • Phone: 719-333-5254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25910
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25910
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR.0067155
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: