Provider Demographics
NPI:1790927812
Name:LIU, LIAN (MD)
Entity Type:Individual
Prefix:
First Name:LIAN
Middle Name:
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 1:600 E. DIXIE AVENUE
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5925
Mailing Address - Country:US
Mailing Address - Phone:352-323-4267
Mailing Address - Fax:352-323-5039
Practice Address - Street 1:1456 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748
Practice Address - Country:US
Practice Address - Phone:352-787-1778
Practice Address - Fax:352-787-1164
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118477207ZC0006X
CODR.0060670207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME118477OtherMEDICAL LICENSE