Provider Demographics
NPI:1528164951
Name:LIU, GEORGE ALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ALBERT
Last Name:LIU
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 1:2300 N EDWARD ST
Mailing Address - Street 2:GSBLL
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4163
Mailing Address - Country:US
Mailing Address - Phone:217-876-2857
Mailing Address - Fax:217-876-2874
Practice Address - Street 1:1 MEMORIAL DR STE 300
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6322
Practice Address - Country:US
Practice Address - Phone:217-876-5500
Practice Address - Fax:217-876-5505
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32494208600000X
IL036126042208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64324940Medicaid
KY020035729Medicare ID - Type UnspecifiedPALMETTO GBA RAILROAD
KYG29499Medicare UPIN
KY1665901Medicare ID - Type Unspecified