Healthcare Provider Details

I. General information

NPI: 1013387828
Provider Name (Legal Business Name): LIGA YUSVIRAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 BROADWAY
BANGOR ME
04401-3979
US

IV. Provider business mailing address

360 BROADWAY
BANGOR ME
04401-3979
US

V. Phone/Fax

Practice location:
  • Phone: 207-907-3283
  • Fax:
Mailing address:
  • Phone: 207-907-3283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA155509
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD21686
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: