Healthcare Provider Details

I. General information

NPI: 1528708021
Provider Name (Legal Business Name): LISA LI ZHAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2148 N DAMEN AVE
CHICAGO IL
60647-4562
US

IV. Provider business mailing address

640 N BROAD ST APT 511
PHILADELPHIA PA
19130-3434
US

V. Phone/Fax

Practice location:
  • Phone: 773-938-8128
  • Fax: 773-938-8126
Mailing address:
  • Phone: 412-759-3871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036178447
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: