MEDICARE: LARRY HANPING LIU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1003923459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY HANPING LIU M.D.

Provider Business Mailing Address
First Line	:	2165 S CHINA PL
Second Line	:	SUITE B
City	:	CHICAGO
State	:	IL
Zip	:	60616-1536
Country	:	US
Telephone Number	:	312-328-1055
Fax Number	:	312-328-1056

Provider Business Practice Location Address
First Line	:	2165 S CHINA PL
Second Line	:	SUITE B
City	:	CHICAGO
State	:	IL
Zip	:	60616-1536
Country	:	US
Telephone Number	:	312-328-1055
Fax Number	:	312-328-1056

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/09/2007

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