Provider Demographics
NPI:1285878983
Name:LIU, ENCHUN MIKE (MD)
Entity type:Individual
Prefix:
First Name:ENCHUN
Middle Name:MIKE
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9910 HUEBNER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1342
Mailing Address - Country:US
Mailing Address - Phone:210-615-7600
Mailing Address - Fax:210-615-8505
Practice Address - Street 1:9910 HUEBNER RD
Practice Address - Street 2:STE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1342
Practice Address - Country:US
Practice Address - Phone:210-615-7600
Practice Address - Fax:210-615-8505
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2019-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2013012522207W00000X
TXQ3399207WX0107X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347266401Medicaid
TX415392ZPHXMedicare PIN