Provider Demographics
NPI:1972765097
Name:LIU, ZHENGJUN (MD)
Entity Type:Individual
Prefix:
First Name:ZHENGJUN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
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:PO BOX 8712
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46898-8712
Mailing Address - Country:US
Mailing Address - Phone:260-969-6200
Mailing Address - Fax:206-407-1447
Practice Address - Street 1:6819 LIMA RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-1145
Practice Address - Country:US
Practice Address - Phone:260-969-6200
Practice Address - Fax:260-407-1447
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263305174400000X
IN01073085A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist