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General NPI Number Information
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NPI Number | 1861988511
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Entity Type | Individual
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Provider Name | BOLUN LIU MD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 1025 MARSH ST
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City | MANKATO
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State | MN
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Zip | 56001
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Country | US
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Telephone | 507-625-4031
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 MARSH ST
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City | MANKATO
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State | MN
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Zip | 56001-4752
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Country | US
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Telephone | 507-625-4031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125071677
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License Number State | IL
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