=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871558536
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YONGMIN LIU
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2006
-----------------------------------------------------
Last Update Date | 10/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17000 HUBBARD DR STE 800
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48126-4205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-240-7595
-----------------------------------------------------
Fax | 248-893-6263
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32905 W 12 MILE RD STE 340
-----------------------------------------------------
City | FARMINGTON HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-893-6236
-----------------------------------------------------
Fax | 248-893-6263
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 4301068183
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 204R00000X
-----------------------------------------------------
Taxonomy Name | Electrodiagnostic Medicine Physician
-----------------------------------------------------
License Number | 4301068183
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 4301068183
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------