Provider Demographics
NPI:1851371397
Name:LIU, MICHELLE FERDINAND (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:FERDINAND
Last Name:LIU
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:FERDINAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,MPH
Mailing Address - Street 1:6261 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2818
Mailing Address - Country:US
Mailing Address - Phone:757-321-1443
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:ENT DEPARTMENT
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-2800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233729207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology