Healthcare Provider Details

I. General information

NPI: 1114914827
Provider Name (Legal Business Name): LI MIN I LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N 12TH STREET UPPER LEVEL
LEMOYNE PA
17043
US

IV. Provider business mailing address

50 N 12TH ST UPPR LEVEL
LEMOYNE PA
17043-1428
US

V. Phone/Fax

Practice location:
  • Phone: 717-737-5767
  • Fax: 717-737-6268
Mailing address:
  • Phone: 717-737-5767
  • Fax: 717-737-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD070672L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: