Healthcare Provider Details

I. General information

NPI: 1528164951
Provider Name (Legal Business Name): GEORGE ALBERT LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEMORIAL DR STE 300
DECATUR IL
62526-6322
US

IV. Provider business mailing address

2300 N EDWARD ST GSBLL
DECATUR IL
62526-4163
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-5500
  • Fax: 217-876-5505
Mailing address:
  • Phone: 217-876-2857
  • Fax: 217-876-2874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number32494
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036126042
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: