Healthcare Provider Details

I. General information

NPI: 1255954574
Provider Name (Legal Business Name): GUANG HAO MAXIMUS LIU MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 08/06/2025
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S BRENTWOOD BLVD DIV NEUROLOGY SLEEP MED, STE 600
SAINT LOUIS MO
63144-1320
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-4342
  • Fax: 314-747-3813
Mailing address:
  • Phone: 314-362-4342
  • Fax: 314-747-3813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2024012227
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: