Healthcare Provider Details

I. General information

NPI: 1053681320
Provider Name (Legal Business Name): LAI-YUAN LIU MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 NW 14TH ST SUITE 602
MIAMI FL
33125-1673
US

IV. Provider business mailing address

PO BOX 161652
MIAMI FL
33116-1652
US

V. Phone/Fax

Practice location:
  • Phone: 305-545-5353
  • Fax: 305-545-5220
Mailing address:
  • Phone: 305-545-5353
  • Fax: 305-545-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LAI-YUAN LIU
Title or Position: MD
Credential: MD
Phone: 305-545-5353