Healthcare Provider Details

I. General information

NPI: 1083668826
Provider Name (Legal Business Name): MARY H LI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 S YALE AVE SUITE 305
TULSA OK
74136-1907
US

IV. Provider business mailing address

6151 S YALE AVE SUITE 305
TULSA OK
74136-1907
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-9494
  • Fax: 918-494-9459
Mailing address:
  • Phone: 918-494-9494
  • Fax: 918-494-9459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number20874
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: