Healthcare Provider Details

I. General information

NPI: 1023677960
Provider Name (Legal Business Name): MICHAEL A. LIU MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 N MICHIGAN AVE STE 1006
CHICAGO IL
60611-2814
US

IV. Provider business mailing address

645 N MICHIGAN AVE STE 1006
CHICAGO IL
60611-2814
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0990
  • Fax: 312-472-0564
Mailing address:
  • Phone: 312-695-0990
  • Fax: 312-472-0564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP04706
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number316957-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036175171
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: