Healthcare Provider Details

I. General information

NPI: 1740365063
Provider Name (Legal Business Name): ZHICHENG LI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NEW WAVERLY PL STE 105
CARY NC
27518-7414
US

IV. Provider business mailing address

530 NEW WAVERLY PL STE 105
CARY NC
27518-7414
US

V. Phone/Fax

Practice location:
  • Phone: 919-897-8895
  • Fax: 919-561-4863
Mailing address:
  • Phone: 919-897-8895
  • Fax: 949-561-4863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number2010-01547
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2010-01547
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: