Healthcare Provider Details

I. General information

NPI: 1790762599
Provider Name (Legal Business Name): NINGCHEN LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 CHAMBERS ST
CRESTLINE OH
44827-1028
US

IV. Provider business mailing address

293 CHAMBERS ST. P.O. BOX 8
CRESTLINE OH
44827-0008
US

V. Phone/Fax

Practice location:
  • Phone: 419-683-3131
  • Fax: 419-683-5016
Mailing address:
  • Phone: 419-683-3131
  • Fax: 419-683-5016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number35 . 045747
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: