Healthcare Provider Details

I. General information

NPI: 1437373834
Provider Name (Legal Business Name): HAIKUN LI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 12/01/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 VETERANS MEMORIAL PKWY
SAINT CHARLES MO
63303-3526
US

IV. Provider business mailing address

2845 VETERANS MEMORIAL PKWY
SAINT CHARLES MO
63303-3526
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-6988
  • Fax: 314-289-6360
Mailing address:
  • Phone: 314-286-6988
  • Fax: 314-289-6360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRL9997
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301092542
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2008031582
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: