Provider Demographics
NPI:1629001300
Name:LIEU, STEVEN (DO)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:LIEU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 4131
Mailing Address - Street 2:
Mailing Address - City:YALESVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06492
Mailing Address - Country:US
Mailing Address - Phone:203-284-1340
Mailing Address - Fax:203-265-4557
Practice Address - Street 1:435 LEWIS AVE
Practice Address - Street 2:MIDSTATE MEDICAL CENTER
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451
Practice Address - Country:US
Practice Address - Phone:203-284-1340
Practice Address - Fax:203-265-4557
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040773207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT040773OtherCONNECTICARE
CT010040773CT01OtherBC
CT2V4960OtherHEALTHNET
P00270222OtherRRMC
P00270222OtherRRMC