Provider Demographics
NPI:1851402721
Name:LIU, MICHAEL XIAOZHONG (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:XIAOZHONG
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:XIAOZHONG
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 MEMORIAL DR STE 230B
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6705
Mailing Address - Country:US
Mailing Address - Phone:618-465-8666
Mailing Address - Fax:
Practice Address - Street 1:4 MEMORIAL DR STE 230
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6751
Practice Address - Country:US
Practice Address - Phone:618-465-8666
Practice Address - Fax:618-465-8670
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT20040154032084N0400X
MO20100119132084N0400X
IL036-1225832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology