Healthcare Provider Details

I. General information

NPI: 1124076724
Provider Name (Legal Business Name): DENNIS B LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE BOX 24
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE BOX 24
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6340
  • Fax: 312-227-9412
Mailing address:
  • Phone: 312-227-6340
  • Fax: 312-227-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036111648
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: