Healthcare Provider Details

I. General information

NPI: 1720512338
Provider Name (Legal Business Name): BAOQIONG LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date: 11/27/2017
Reactivation Date: 01/10/2018

III. Provider practice location address

100 N EDINBURGH DR STE 102
WINTER PARK FL
32792-4125
US

IV. Provider business mailing address

100 N EDINBURGH DR STE 102
WINTER PARK FL
32792-4125
US

V. Phone/Fax

Practice location:
  • Phone: 407-845-8366
  • Fax:
Mailing address:
  • Phone: 407-845-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-47107
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA11391500
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME171085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: