Provider Demographics
NPI:1134509987
Name:LIU, PETER (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1625 RAMBLEWOOD DR STE 1
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6367
Mailing Address - Country:US
Mailing Address - Phone:517-324-3700
Mailing Address - Fax:517-364-8119
Practice Address - Street 1:1625 RAMBLEWOOD DR STE 1
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6367
Practice Address - Country:US
Practice Address - Phone:517-324-3700
Practice Address - Fax:517-324-4588
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101021559208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology