Healthcare Provider Details

I. General information

NPI: 1891436622
Provider Name (Legal Business Name): FAN-JEAN LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 N MAYFAIR RD FL 3
MILWAUKEE WI
53226-3464
US

IV. Provider business mailing address

1155 N MAYFAIR RD FL 3
MILWAUKEE WI
53226-3464
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-8998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number82513-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: