Provider Demographics
NPI:1285740043
Name:LIU, BENJAMIN P (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:P
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST FL 14
Mailing Address - Street 2:DEPT NEURORADIOLOGY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2951
Mailing Address - Country:US
Mailing Address - Phone:312-695-1292
Mailing Address - Fax:
Practice Address - Street 1:676 N SAINT CLAIR ST FL 14
Practice Address - Street 2:DEPT NEURORADIOLOGY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2951
Practice Address - Country:US
Practice Address - Phone:312-695-1292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1181912085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology