Provider Demographics
NPI:1427312669
Name:BUELL, LIUDMILA (MD)
Entity type:Individual
Prefix:DR
First Name:LIUDMILA
Middle Name:
Last Name:BUELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIUDMILA
Other - Middle Name:
Other - Last Name:YUNCHENKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1345 W BAY DR STE 202
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2276
Mailing Address - Country:US
Mailing Address - Phone:727-559-0895
Mailing Address - Fax:727-518-7633
Practice Address - Street 1:1345 W BAY DR STE 202
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2276
Practice Address - Country:US
Practice Address - Phone:727-559-0895
Practice Address - Fax:727-518-7633
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122555207Q00000X, 207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015234700Medicaid