Provider Demographics
NPI:1689297202
Name:ALICEA, LISA LIANG (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LIANG
Last Name:ALICEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MEDICAL PARK LN STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4981
Mailing Address - Country:US
Mailing Address - Phone:936-291-2116
Mailing Address - Fax:844-655-5471
Practice Address - Street 1:123 MEDICAL PARK LN STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4981
Practice Address - Country:US
Practice Address - Phone:936-291-2116
Practice Address - Fax:844-655-5471
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10070765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine