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General NPI Number Information
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NPI Number | 1144315201
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Entity Type | Organization
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Legal Business Name | LILIANE GRAND'BOIS MD PA
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 151 NW 11TH ST SUITE # E-204
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City | HOMESTEAD
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State | FL
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Zip | 33030-4360
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Country | US
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Telephone | 305-245-3260
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Fax | 786-335-1050
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Provider Business Mailing Address
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Address Line | 151 NW 11TH ST SUITE # E-204
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City | HOMESTEAD
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State | FL
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Zip | 33030-4360
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Country | US
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Telephone | 305-245-3260
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Fax | 786-335-1050
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | DR. LILIANE GRAND'BOIS
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Credential | M.D.
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Telephone | 305-245-3260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME55284
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License Number State | FL
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