Provider Demographics
NPI:1659566545
Name:LIU, CONNIE X (MD,)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:X
Last Name:LIU
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:MS
Other - First Name:XIA
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3867 TURTLE RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4227
Mailing Address - Country:US
Mailing Address - Phone:732-766-6976
Mailing Address - Fax:
Practice Address - Street 1:1979 W HILLSBORO BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1444
Practice Address - Country:US
Practice Address - Phone:954-428-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11943704OtherCAQH
FL012569200Medicaid
FLHZ646ZMedicare UPIN