Provider Demographics
NPI:1083275143
Name:LI, CHANGZHAO (BACHELOR OF MEDICINE)
Entity type:Individual
Prefix:
First Name:CHANGZHAO
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:BACHELOR OF MEDICINE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 166324
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-6324
Mailing Address - Country:US
Mailing Address - Phone:239-624-3570
Mailing Address - Fax:239-624-3571
Practice Address - Street 1:350 7TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5754
Practice Address - Country:US
Practice Address - Phone:239-624-3570
Practice Address - Fax:239-624-3571
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME167147207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology