Provider Demographics
NPI:1972037158
Name:LIU, SIWEN (DO)
Entity Type:Individual
Prefix:
First Name:SIWEN
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1100 BERGSLIEN ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002-2600
Mailing Address - Country:US
Mailing Address - Phone:715-684-1111
Mailing Address - Fax:715-684-1119
Practice Address - Street 1:1100 BERGSLIEN ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-2600
Practice Address - Country:US
Practice Address - Phone:715-684-1111
Practice Address - Fax:715-684-1119
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI81075208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery