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General NPI Number Information
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NPI Number | 1154682003
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Entity Type | Individual
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Provider Name | DANIEL PENG LIU M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 24 SAINT CHARLES PL
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-5106
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Country | US
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Telephone | 309-363-5955
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Fax |
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Provider Business Mailing Address
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Address Line | 24 SAINT CHARLES PL
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-5106
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Country | US
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Telephone | 309-363-5955
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036.144453
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License Number State | IL
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