Provider Demographics
NPI:1194709188
Name:GE, LI LISA (MD)
Entity type:Individual
Prefix:
First Name:LI
Middle Name:LISA
Last Name:GE
Suffix:
Gender:F
Credentials:MD
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 28949
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8949
Mailing Address - Country:US
Mailing Address - Phone:559-228-5492
Mailing Address - Fax:
Practice Address - Street 1:6121 N THESTA ST STE 204
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5294
Practice Address - Country:US
Practice Address - Phone:559-438-7390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47917207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN458940800Medicaid
MNI35227Medicare UPIN
MN458940800Medicaid