MEDICARE: FRISCO AND PLANO CHILDREN DOCTOR

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	208000000X	Pediatrics Physician	N9464	TX

General Provider Information

NPI Number	:	1265846893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRISCO AND PLANO CHILDREN DOCTOR

Provider Business Mailing Address
First Line	:	6833 COIT RD STE 102
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-5400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6833 COIT RD STE 102
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-5400
Country	:	US
Telephone Number	:	972-268-7068
Fax Number	:	972-767-3058

Authorized Official
Title or Position	:	OWNER
Name	:	LI LI
Credential	:	MD
Telephone Number	:	301-880-4289

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	06/16/2014

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