Provider Demographics
NPI:1235292814
Name:UNG, BOLIDY D (MD)
Entity Type:Individual
Prefix:
First Name:BOLIDY
Middle Name:D
Last Name:UNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BOLIDY
Other - Middle Name:D
Other - Last Name:UNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 551420
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-1420
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:855-851-4405
Practice Address - Street 1:4725 N. FEDERAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4603
Practice Address - Country:US
Practice Address - Phone:954-771-8000
Practice Address - Fax:954-776-3270
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62078207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379590000Medicaid
FL17672OtherBLUE CROSS BLUE SHIELD
FL17672OtherBLUE CROSS BLUE SHIELD
FLF42871Medicare UPIN
FL17672VMedicare PIN