MEDICARE: BERNARDO F LI MD GARDENIA J PAJUNAR-LI MD LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	036052771	IL

General Provider Information

NPI Number	:	1235407982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERNARDO F LI MD GARDENIA J PAJUNAR-LI MD LTD

Provider Business Mailing Address
First Line	:	11309 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-4911
Country	:	US
Telephone Number	:	773-264-2020
Fax Number	:	773-264-7960

Provider Business Practice Location Address
First Line	:	11309 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-4911
Country	:	US
Telephone Number	:	773-264-2020
Fax Number	:	773-264-7960

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BERNARDO LI
Credential	:	M.D.
Telephone Number	:	773-264-2020

Provider Enumeration Date	:	12/09/2011
Last Update Date	:	12/14/2011

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