Provider Demographics
NPI:1518427566
Name:BASTIN, LIZA BELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LIZA
Middle Name:BELLE
Last Name:BASTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 S LIMESTONE CTW 304
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-323-9918
Mailing Address - Fax:859-323-1197
Practice Address - Street 1:900 S LIMESTONE CTW 304
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-323-9918
Practice Address - Fax:859-323-1197
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine