Provider Demographics
NPI:1174712970
Name:BLESSILDA B. LIU M.D., P.A.
Entity type:Organization
Organization Name:BLESSILDA B. LIU M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:BLESSILDA
Authorized Official - Middle Name:BOHOLST
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:352-746-4684
Mailing Address - Street 1:2623 N FOREST RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-5123
Mailing Address - Country:US
Mailing Address - Phone:352-746-4684
Mailing Address - Fax:352-746-5784
Practice Address - Street 1:2623 N FOREST RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-5123
Practice Address - Country:US
Practice Address - Phone:352-746-4684
Practice Address - Fax:352-746-5784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072471207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0072471OtherLISCENCE
FLG45324Medicare UPIN
FLK3546Medicare PIN