Healthcare Provider Details

I. General information

NPI: 1235207028
Provider Name (Legal Business Name): LING LI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 S FREMONT AVE STE 3000
SPRINGFIELD MO
65804-2239
US

IV. Provider business mailing address

PO BOX 2580
SPRINGFIELD MO
65801-2580
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-9123
  • Fax:
Mailing address:
  • Phone: 417-829-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2004004247
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: