Provider Demographics
NPI:1558479808
Name:LIU, MICHAEL LS (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LS
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:PO BOX 5785
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304
Mailing Address - Country:US
Mailing Address - Phone:503-587-0623
Mailing Address - Fax:503-391-7422
Practice Address - Street 1:2700 SE STRATUS AVE UNIT 401
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6258
Practice Address - Country:US
Practice Address - Phone:503-434-5160
Practice Address - Fax:503-434-5120
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21008207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR145375Medicare PIN
ORF35621Medicare UPIN
OR5262680001Medicare NSC