Provider Demographics
NPI:1588646509
Name:LIOU, WEN (MD)
Entity Type:Individual
Prefix:
First Name:WEN
Middle Name:
Last Name:LIOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2040C TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-2178
Mailing Address - Country:US
Mailing Address - Phone:941-629-4464
Mailing Address - Fax:941-629-4701
Practice Address - Street 1:2040C TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2178
Practice Address - Country:US
Practice Address - Phone:941-629-4464
Practice Address - Fax:941-629-4701
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65777208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27254OtherBLUECROSS
FL11149OtherSTAYWELL
FL4034927OtherCIGNA