Healthcare Provider Details

I. General information

NPI: 1841210549
Provider Name (Legal Business Name): MICHAEL LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16811 SE MCGILLIVRAY BLVD
VANCOUVER WA
98683-0400
US

IV. Provider business mailing address

16811 SE MCGILLIVRAY BLVD
VANCOUVER WA
98683-0400
US

V. Phone/Fax

Practice location:
  • Phone: 360-750-3220
  • Fax: 360-735-3400
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00039664
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: