Healthcare Provider Details

I. General information

NPI: 1013379791
Provider Name (Legal Business Name): CHE LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 S DALE MABRY HWY
TAMPA FL
33629-6335
US

IV. Provider business mailing address

79 FLAGG CT
STATEN ISLAND NY
10304-1157
US

V. Phone/Fax

Practice location:
  • Phone: 813-798-1499
  • Fax: 813-439-6545
Mailing address:
  • Phone: 646-409-2508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number309005
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberME183557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: