Provider Demographics
NPI:1053528646
Name:JIANMEI LIU, MD, LLC
Entity type:Organization
Organization Name:JIANMEI LIU, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIANMEI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-644-6400
Mailing Address - Street 1:6400 CLAYTON AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117
Mailing Address - Country:US
Mailing Address - Phone:314-644-6500
Mailing Address - Fax:314-644-6501
Practice Address - Street 1:6400 CLAYTON AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117
Practice Address - Country:US
Practice Address - Phone:314-644-6500
Practice Address - Fax:314-644-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2015-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004024409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507011500Medicaid
MO507011500Medicaid
MO000015306Medicare PIN