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NPI Code Detail

MEDICARE: LILIANA BUSTAMANTE MD

MEDICARE: LILIANA BUSTAMANTE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RH0000XHematology (Internal Medicine) PhysicianME119232FL
2207RX0202XMedical Oncology PhysicianME119232FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881987303
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILIANA BUSTAMANTE MD
Provider Business Mailing Address
First Line : PO BOX 102222
Second Line :
City : ATLANTA
State : GA
Zip : 30368-2222
Country : US
Telephone Number : 239-274-8200
Fax Number :
Provider Business Practice Location Address
First Line : 1030 COMMERCE CREEK BLVD
Second Line :
City : CAPE CORAL
State : FL
Zip : 33909-6529
Country : US
Telephone Number : 239-772-3544
Fax Number : 239-772-7855
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2011
Last Update Date : 02/09/2026

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Directions to “ LILIANA BUSTAMANTE MD” Practice Location

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