Provider Demographics
NPI:1750357737
Name:LIU, JEANNETTE MAE (MD)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:MAE
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1026 A AVE NE STE 5000
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5036
Mailing Address - Country:US
Mailing Address - Phone:319-369-7085
Mailing Address - Fax:319-368-5770
Practice Address - Street 1:1026 A AVE NE STE 5000
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5036
Practice Address - Country:US
Practice Address - Phone:319-369-7085
Practice Address - Fax:319-368-5770
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA254458207T00000X
CAA96830207T00000X
TXL5436207T00000X
IAMD-44453207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211416702Medicaid
TX378598YKS4Medicare PIN