Liem, Edwin Boediono

Liem, Edwin Boediono is an individual health care provider with primary practice located at 1850 State St , New Albany IN 47150-4990. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Liem, Edwin Boediono can be contacted via phone (502) 625-5584.

Contact Information

Primary practice address
1850 State St New Albany IN 47150-4990
Phone: (502) 625-5584
Fax: (502) 426-2264
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 36354 Kentucky
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 01066649A Indiana

Profile Details

NPI number 1952354623
LBN Legal business name Liem, Edwin Boediono
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2006
Last updated Jan 12th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952354623 NPPES
Kentucky MEDICAID 64041981
Kentucky Other P00819295
Kentucky Other 000000640496
Kentucky Other 50027044
Kentucky Other 111870
Kentucky Other 50027044
Kentucky MEDICAID 200366540

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