Healthcare Provider Details

I. General information

NPI: 1851402721
Provider Name (Legal Business Name): MICHAEL XIAOZHONG LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: XIAOZHONG LIU

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MEMORIAL DR STE 230
ALTON IL
62002-6751
US

IV. Provider business mailing address

4 MEMORIAL DR STE 230B
ALTON IL
62002-6705
US

V. Phone/Fax

Practice location:
  • Phone: 618-465-8666
  • Fax: 618-465-8670
Mailing address:
  • Phone: 618-465-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberT2004015403
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2010011913
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036-122583
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: