Provider Demographics
NPI:1043214414
Name:LIEUWEN, DAVID FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:FRANCIS
Last Name:LIEUWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 EAST PARIS AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3680
Mailing Address - Country:US
Mailing Address - Phone:616-459-3158
Mailing Address - Fax:616-742-1945
Practice Address - Street 1:1000 EAST PARIS AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-459-3158
Practice Address - Fax:616-742-1945
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40601207Q00000X
MI4301098801207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COI04085Medicare UPIN
MI0D16122038Medicare PIN
CO39056775Medicaid
CO018017OtherKAISER-COMMERCIAL NUMBER