Healthcare Provider Details

I. General information

NPI: 1699741041
Provider Name (Legal Business Name): SHOUPING LI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E HASKELL ST STE A
WINNEMUCCA NV
89445-3576
US

IV. Provider business mailing address

10282 VIA COMO
RENO NV
89511-4324
US

V. Phone/Fax

Practice location:
  • Phone: 775-304-8748
  • Fax: 775-625-8580
Mailing address:
  • Phone: 775-304-8748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number36387
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number12382
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12382
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: