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General NPI Number Information
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NPI Number | 1033102744
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Entity Type | Individual
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Provider Name | INGRID Y LIU DO
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Gender | Female
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 917 S OAK PARK AVE STE B
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City | OAK PARK
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State | IL
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Zip | 60304-1950
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Country | US
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Telephone | 708-386-3080
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Fax | 708-386-3084
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Provider Business Mailing Address
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Address Line | 917 S OAK PARK AVE STE B
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City | OAK PARK
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State | IL
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Zip | 60304-1950
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Country | US
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Telephone | 708-386-3080
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Fax | 708-386-3084
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036098244
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License Number State | IL
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