Healthcare Provider Details

I. General information

NPI: 1043474042
Provider Name (Legal Business Name): JIJUN LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 N. WOOD SAGE ROAD
PEORIA IL
61615
US

IV. Provider business mailing address

8940 N. WOOD SAGE ROAD
PEORIA IL
61615
US

V. Phone/Fax

Practice location:
  • Phone: 309-243-3000
  • Fax: 309-243-3215
Mailing address:
  • Phone: 309-243-3000
  • Fax: 309-243-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA104839
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME105397
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036.130012
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: