Healthcare Provider Details

I. General information

NPI: 1639599665
Provider Name (Legal Business Name): JULIE Y. LI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YUE ZHANG MD

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DR
TAMPA FL
33612-9416
US

IV. Provider business mailing address

PO BOX 198441
ATLANTA GA
30384-8441
US

V. Phone/Fax

Practice location:
  • Phone: 813-745-4673
  • Fax:
Mailing address:
  • Phone: 813-745-7365
  • Fax: 813-449-8618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number282267
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number282267
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberME156196
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: