Healthcare Provider Details

I. General information

NPI: 1831754316
Provider Name (Legal Business Name): CAITLIN LI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 UNIVERSITY DR STE 102
MARINETTE WI
54143-4110
US

IV. Provider business mailing address

3003 UNIVERSITY DR STE 102
MARINETTE WI
54143-4110
US

V. Phone/Fax

Practice location:
  • Phone: 715-735-8056
  • Fax: 715-735-8057
Mailing address:
  • Phone: 715-735-8056
  • Fax: 715-735-8057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number87564-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: