Healthcare Provider Details

I. General information

NPI: 1073678504
Provider Name (Legal Business Name): HONG LIU WILSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HONG LIU M.D.

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 NEW HAVEN RD
HARRISON OH
45030-1657
US

IV. Provider business mailing address

2415 AUBURN AVE.
CINCINNATI OH
45219-2701
US

V. Phone/Fax

Practice location:
  • Phone: 513-367-5888
  • Fax: 513-367-1015
Mailing address:
  • Phone: 513-221-4949
  • Fax: 513-241-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35087103
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: