Provider Demographics
NPI:1871558536
Name:LIU, YONGMIN
Entity type:Individual
Prefix:
First Name:YONGMIN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32905 W 12 MILE RD
Mailing Address - Street 2:STE 340
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:248-893-6236
Mailing Address - Fax:248-893-6263
Practice Address - Street 1:17000 HUBBARD DR STE 800
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4205
Practice Address - Country:US
Practice Address - Phone:313-240-7595
Practice Address - Fax:248-893-6263
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068183208100000X, 204R00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI250H22820OtherBCBSM/BCN
MIH71300OtherHEALTH ALLIANE PLANS
MI4682428Medicaid
MI023759OtherMIDWEST HEALTH PLAN
MI50843OtherOMNICARE HEALTH PLAN
MI144912OtherGREAT LAKES HEALTH PLAN
MI4477536OtherAETNA
MI4682428Medicaid
MIH71300OtherHEALTH ALLIANE PLANS
MI0Q26284016Medicare ID - Type Unspecified