Provider Demographics
NPI:1235271586
Name:WILLAMETTE NEUROSURGERY, PC
Entity Type:Organization
Organization Name:WILLAMETTE NEUROSURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-434-5160
Mailing Address - Street 1:PO BOX 5785
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-0785
Mailing Address - Country:US
Mailing Address - Phone:503-587-0623
Mailing Address - Fax:503-391-7422
Practice Address - Street 1:2700 SE STRATUS AVE UNIT 401
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6258
Practice Address - Country:US
Practice Address - Phone:503-434-5160
Practice Address - Fax:503-434-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21008207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5262680001Medicare NSC
ORF35621Medicare UPIN
OR104070Medicare PIN