MEDICARE: DR. TINA YULING LIAO 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	2080A0000X	Pediatric Adolescent Medicine Physician	41634	AZ
2	2080A0000X	Pediatric Adolescent Medicine Physician	233363	NY
3	208000000X	Pediatrics Physician	41634	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063636512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINA YULING LIAO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 10097
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85130-0020
Country	:	US
Telephone Number	:	520-836-3446
Fax Number	:

Provider Business Practice Location Address
First Line	:	1856 E FLORENCE BLVD STE 1
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-5303
Country	:	US
Telephone Number	:	520-836-5036
Fax Number	:	520-316-0365

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	12/02/2021

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