Provider Demographics
NPI:1154682003
Name:LIU, DANIEL PENG (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PENG
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 1:24 SAINT CHARLES PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5106
Mailing Address - Country:US
Mailing Address - Phone:309-363-5955
Mailing Address - Fax:
Practice Address - Street 1:24 SAINT CHARLES PL
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-5106
Practice Address - Country:US
Practice Address - Phone:309-363-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.144453207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology