Healthcare Provider Details

I. General information

NPI: 1477830511
Provider Name (Legal Business Name): DIANNA LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 POINT WEST BLVD
SAINT CHARLES MO
63301-4431
US

IV. Provider business mailing address

9 POINT WEST BLVD
SAINT CHARLES MO
63301-4431
US

V. Phone/Fax

Practice location:
  • Phone: 636-441-7900
  • Fax:
Mailing address:
  • Phone: 636-441-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036.142384
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT205315
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125065402
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2021015991
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: