Healthcare Provider Details

I. General information

NPI: 1275503971
Provider Name (Legal Business Name): MARY M LI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7154 MEDICAL CENTER DR
SPRING HILL FL
34608-1329
US

IV. Provider business mailing address

4371 VERONICA S SHOEMAKER BLVD ATTN: CREDENTIAL DEPT
FORT MYERS FL
33916-2216
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-1926
  • Fax: 352-597-2154
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME84859
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: