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General NPI Number Information
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NPI Number | 1043551690
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Entity Type | Organization
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Legal Business Name | WING CARDIOLOGY AND HEALTH LLC
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 10/19/2018
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Provider Practice Location Address
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Address Line | 161 N CAUSEWAY STE C
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-5300
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Country | US
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Telephone | 386-424-8440
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Fax |
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Provider Business Mailing Address
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Address Line | 161 N CAUSEWAY STE C
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-5300
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Country | US
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Telephone | 386-424-8400
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | WING YI LIU
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Credential | MD
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Telephone | 386-424-8440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME97585
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License Number State | FL
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