Provider Demographics
NPI:1225489255
Name:LIU, MIKE (DO)
Entity Type:Individual
Prefix:
First Name:MIKE
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 1:900 JEROME ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3939
Mailing Address - Country:US
Mailing Address - Phone:817-924-6200
Mailing Address - Fax:817-924-6201
Practice Address - Street 1:900 JEROME ST STE 102
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3939
Practice Address - Country:US
Practice Address - Phone:817-924-6200
Practice Address - Fax:817-924-6201
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS07292084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology