Healthcare Provider Details

I. General information

NPI: 1710365697
Provider Name (Legal Business Name): ZHAN LI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 W FAIDLEY AVE
GRAND ISLAND NE
68803-4205
US

IV. Provider business mailing address

2620 W FAIDLEY AVE
GRAND ISLAND NE
68803-4205
US

V. Phone/Fax

Practice location:
  • Phone: 308-384-4600
  • Fax:
Mailing address:
  • Phone: 308-398-5669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberP31357
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: