Healthcare Provider Details

I. General information

NPI: 1760575740
Provider Name (Legal Business Name): MARILYN YOUNG LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARILYN SUU YING YOUNG MD

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9009 LIGON CT
FORT MYERS FL
33908-3602
US

IV. Provider business mailing address

9009 LIGON COURT
FORT MYERS FL
33908-3602
US

V. Phone/Fax

Practice location:
  • Phone: 239-481-2355
  • Fax: 239-481-9484
Mailing address:
  • Phone: 239-481-2355
  • Fax: 239-481-9484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME38652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: