Provider Demographics
NPI:1487683249
Name:LIENS, HERMES B (MD)
Entity Type:Individual
Prefix:
First Name:HERMES
Middle Name:B
Last Name:LIENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 SW 130TH AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3414
Mailing Address - Country:US
Mailing Address - Phone:305-226-2535
Mailing Address - Fax:305-226-2536
Practice Address - Street 1:4155 SW 130TH AVE STE 113
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3414
Practice Address - Country:US
Practice Address - Phone:305-226-2535
Practice Address - Fax:305-226-2536
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91479208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003339400Medicaid
FLU20942Medicare ID - Type UnspecifiedMEDICARE
FL28611OtherBLUE CROSS BLUE SHIELD