Healthcare Provider Details

I. General information

NPI: 1871656272
Provider Name (Legal Business Name): LIU LIN THIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KWEE THIO MD

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL STE 2D STE 2D
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8111
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-4089
  • Fax: 314-454-4225
Mailing address:
  • Phone: 314-454-4089
  • Fax: 314-454-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number101090
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: