Provider Demographics
NPI:1093032278
Name:HELGEMO & LIOU PEDIATRICS
Entity Type:Organization
Organization Name:HELGEMO & LIOU PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DEWITT
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:HELGEMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-629-4464
Mailing Address - Street 1:2040C TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-2178
Mailing Address - Country:US
Mailing Address - Phone:941-629-4464
Mailing Address - Fax:941-629-4701
Practice Address - Street 1:2040C TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2178
Practice Address - Country:US
Practice Address - Phone:941-629-4464
Practice Address - Fax:941-629-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45354OtherBCBS OF FL