Provider Demographics
NPI:1871510396
Name:LIEU, CHARLES H (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
Last Name:LIEU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 HIGHLANDS PLAZA DR E STE 220
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1351
Mailing Address - Country:US
Mailing Address - Phone:314-273-0195
Mailing Address - Fax:
Practice Address - Street 1:1110 HIGHLANDS PLAZA DR E STE 220
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1351
Practice Address - Country:US
Practice Address - Phone:314-273-0195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103617207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208263012Medicaid
MO208263012Medicaid
110127442Medicare PIN
MO208263012Medicaid
IL$$$$$$$$$Medicaid