=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952539470
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK LIU M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2009
-----------------------------------------------------
Last Update Date | 10/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 E BOULDER ST STE 2508
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80909-5533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-365-6999
-----------------------------------------------------
Fax | 719-365-2837
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10TH MDG 4102 PINION DR
-----------------------------------------------------
City | USAF ACADEMY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-333-5254
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 25910
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 25910
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | DR.0067155
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------