Provider Demographics
NPI:1720022601
Name:LIU, BLESSILDA BOHOLST (MD)
Entity Type:Individual
Prefix:MRS
First Name:BLESSILDA
Middle Name:BOHOLST
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 640524
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34464-0524
Mailing Address - Country:US
Mailing Address - Phone:352-746-4684
Mailing Address - Fax:352-746-5784
Practice Address - Street 1:942 E NORVELL BRYANT HWY
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-2826
Practice Address - Country:US
Practice Address - Phone:352-419-8924
Practice Address - Fax:352-419-8927
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072471207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253280800Medicaid
FL32942ZMedicare PIN
G45324Medicare UPIN