Provider Demographics
NPI:1215977327
Name:LI, LI (MD)
Entity type:Individual
Prefix:
First Name:LI
Middle Name:
Last Name:LI
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 1:74 ROUTE 6A
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-1864
Mailing Address - Country:US
Mailing Address - Phone:508-833-1569
Mailing Address - Fax:508-888-8936
Practice Address - Street 1:74 ROUTE 6A
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-1864
Practice Address - Country:US
Practice Address - Phone:508-833-1569
Practice Address - Fax:508-888-8936
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001001898207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200950608Medicaid
MOH41558Medicare UPIN
MO200950608Medicaid