Healthcare Provider Details

I. General information

NPI: 1013689512
Provider Name (Legal Business Name): THOMAS LI CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2021
Last Update Date: 10/02/2021
Certification Date: 10/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 MAIN ST STE 210
LAFAYETTE IN
47901-1369
US

IV. Provider business mailing address

427 MAIN ST STE 210
LAFAYETTE IN
47901-1369
US

V. Phone/Fax

Practice location:
  • Phone: 765-404-8099
  • Fax:
Mailing address:
  • Phone: 765-404-8099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOHN MARTIN THOMAS
Title or Position: CEO
Credential: MD
Phone: 765-404-8099