Healthcare Provider Details

I. General information

NPI: 1548825417
Provider Name (Legal Business Name): DAVID NANLIN LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 SOUTH JACKSON STREET 3RD FLOOR, STE. A3L15
LOUISVILLE KY
40202
US

IV. Provider business mailing address

550 SOUTH JACKSON STREET 3RD FLOOR, STE. A3L15
LOUISVILLE KY
40202
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-4600
  • Fax:
Mailing address:
  • Phone: 502-588-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberR6293
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberR6293
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number61049
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: