Provider Demographics
NPI:1679540330
Name:LIANG, JEFFREY Y (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:Y
Last Name:LIANG
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 1:10322 N JULIET CT
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1199
Mailing Address - Country:US
Mailing Address - Phone:309-243-8598
Mailing Address - Fax:309-243-9895
Practice Address - Street 1:10322 N JULIET CT
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1199
Practice Address - Country:US
Practice Address - Phone:309-243-8598
Practice Address - Fax:309-243-9895
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL572470Medicare ID - Type Unspecified