Provider Demographics
NPI:1598955783
Name:LIU, NATHANIEL TE TZE (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:TE TZE
Last Name:LIU
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3 AUDUBON PLAZA DR STE 220
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1319
Practice Address - Country:US
Practice Address - Phone:502-636-7242
Practice Address - Fax:502-636-7130
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2021-01-19
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Provider Licenses
StateLicense IDTaxonomies
KY472602086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK142700OtherMEDICARE
KY7100310380Medicaid