Healthcare Provider Details

I. General information

NPI: 1881776425
Provider Name (Legal Business Name): CARLOS M. LI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUFFALO VA HOSPITAL 3495 BAILEY AVE.
BUFFALO NY
14215
US

IV. Provider business mailing address

14 LYMAN RD
AMHERST NY
14226-4116
US

V. Phone/Fax

Practice location:
  • Phone: 716-862-6075
  • Fax:
Mailing address:
  • Phone: 716-862-6075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number223837
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: