Provider Demographics
NPI:1780640367
Name:LIU, EILEEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:A
Last Name:LIU
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 1:3087 PROFESSIONAL PLZ
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7912
Mailing Address - Country:US
Mailing Address - Phone:901-761-0800
Mailing Address - Fax:901-761-7738
Practice Address - Street 1:3087 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-7912
Practice Address - Country:US
Practice Address - Phone:901-761-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35493207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3865657Medicaid
H41002Medicare UPIN
3865657Medicare ID - Type Unspecified