Healthcare Provider Details

I. General information

NPI: 1386173565
Provider Name (Legal Business Name): LIN LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 S WOODS MILL RD
CHESTERFIELD MO
63017-3406
US

IV. Provider business mailing address

232 S WOODS MILL RD
CHESTERFIELD MO
63017-3406
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-6736
  • Fax: 314-576-2319
Mailing address:
  • Phone: 314-205-6736
  • Fax: 314-576-2319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1386173565
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.139388
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017016921
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: