Healthcare Provider Details

I. General information

NPI: 1174939334
Provider Name (Legal Business Name): YILI ZHOU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 ROLLING ACRES RD 102
LADY LAKE FL
32159-5027
US

IV. Provider business mailing address

5525 BANANA POINT DR
OKAHUMPKA FL
34762-3334
US

V. Phone/Fax

Practice location:
  • Phone: 352-751-6582
  • Fax: 352-752-6585
Mailing address:
  • Phone: 352-751-6582
  • Fax: 352-752-6585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME86840
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME86840
License Number StateFL

VIII. Authorized Official

Name: YILI ZHOU
Title or Position: PRESIDENT
Credential: MD
Phone: 352-751-6585