MEDICARE: MIKE LIU DO

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	2084N0400X	Neurology Physician	S0729	TX

General Provider Information

NPI Number	:	1225489255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKE LIU DO

Provider Business Mailing Address
First Line	:	900 JEROME ST STE 102
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3939
Country	:	US
Telephone Number	:	817-924-6200
Fax Number	:	817-924-6201

Provider Business Practice Location Address
First Line	:	900 JEROME ST STE 102
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3939
Country	:	US
Telephone Number	:	817-924-6200
Fax Number	:	817-924-6201

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

Provider Enumeration Date	:	06/30/2016
Last Update Date	:	08/11/2022

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