Provider Demographics
NPI:1114914827
Name:LIU, LI MIN I (MD)
Entity Type:Individual
Prefix:DR
First Name:LI
Middle Name:MIN I
Last Name:LIU
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 1:50 N 12TH ST UPPR LEVEL
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1428
Mailing Address - Country:US
Mailing Address - Phone:717-737-5767
Mailing Address - Fax:717-737-6268
Practice Address - Street 1:50 N 12TH STREET
Practice Address - Street 2:UPPER LEVEL
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043
Practice Address - Country:US
Practice Address - Phone:717-737-5767
Practice Address - Fax:717-737-6268
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070672L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA819303OtherHIGHMARK BLUE SHIELD
PA0017937280001Medicaid
PA110202395OtherPALMETO GBA-UNITED HEALTHCARE
PA02141801OtherCAPITAL BLUE CROSS
PA127026OtherCOVENTRY
PA7795937OtherAETNA
PA7795937OtherAETNA
PA127026OtherCOVENTRY
PA0017937280001Medicaid