MEDICARE: CLINTON LIANG PA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1386330991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLINTON LIANG PA

Provider Business Mailing Address
First Line	:	3034 S UNION AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3019
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3034 S UNION AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3019
Country	:	US
Telephone Number	:	312-804-2028
Fax Number	:

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

Provider Enumeration Date	:	04/17/2023
Last Update Date	:	04/17/2023

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Directions to “ CLINTON LIANG PA” Practice Location

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