Provider Demographics
NPI:1710071311
Name:GRAND'BOIS, LILIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:LILIANE
Middle Name:
Last Name:GRAND'BOIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 NE 30TH TER STE 202
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7614
Mailing Address - Country:US
Mailing Address - Phone:305-246-1030
Mailing Address - Fax:
Practice Address - Street 1:925 NE 30TH TER STE 202
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7614
Practice Address - Country:US
Practice Address - Phone:305-246-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55284208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253720600Medicaid
FLBG1983813OtherDEA NUMBER
FL253720600Medicaid