Healthcare Provider Details

I. General information

NPI: 1770914459
Provider Name (Legal Business Name): CARL LI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CARL LI M.D.

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 FARBER HALL 3435 MAIN STREET
BUFFALO NY
14214-8001
US

IV. Provider business mailing address

270 FARBER HALL 3435 MAIN STREET
BUFFALO NY
14214-8001
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-5382
  • Fax:
Mailing address:
  • Phone: 716-829-5382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number214130-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: