Healthcare Provider Details

I. General information

NPI: 1609875566
Provider Name (Legal Business Name): JENN YU LIU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date: 03/20/2006
Reactivation Date: 04/10/2006

III. Provider practice location address

5100 MARSH RD STE H
OKEMOS MI
48864-1195
US

IV. Provider business mailing address

2001 COOLIDGE RD
EAST LANSING MI
48823-1378
US

V. Phone/Fax

Practice location:
  • Phone: 517-349-0150
  • Fax: 517-349-0157
Mailing address:
  • Phone: 517-337-0316
  • Fax: 517-337-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number5101012517
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: