Healthcare Provider Details

I. General information

NPI: 1659898716
Provider Name (Legal Business Name): DANIEL LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E HURON ST STE 1-200
CHICAGO IL
60611-2909
US

IV. Provider business mailing address

240 E HURON ST STE 1-200
CHICAGO IL
60611-2909
US

V. Phone/Fax

Practice location:
  • Phone: 312-503-7975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA180203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: