Provider Demographics
NPI:1306115530
Name:LI, JIA F (PHARMD,MBA)
Entity type:Individual
Prefix:MR
First Name:JIA
Middle Name:F
Last Name:LI
Suffix:
Gender:M
Credentials:PHARMD,MBA
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:958 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2217
Mailing Address - Country:US
Mailing Address - Phone:847-507-1711
Mailing Address - Fax:
Practice Address - Street 1:2900 N LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5640
Practice Address - Country:US
Practice Address - Phone:773-665-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051285873282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital