Basic Information
| Provider Information | |||||||||
| NPI: | 1285740043 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LIU | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 676 N SAINT CLAIR ST FL 14 | ||||||||
| Address2: | DEPT NEURORADIOLOGY | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126951292 | ||||||||
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| Practice Location | |||||||||
| Address1: | 676 N SAINT CLAIR ST FL 14 | ||||||||
| Address2: | DEPT NEURORADIOLOGY | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126951292 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 07/09/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 036.118191 | IL | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
No ID Information.