Healthcare Provider Details

I. General information

NPI: 1952418097
Provider Name (Legal Business Name): ULYSSES K. LI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: B. U. KWANG LI MD

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE PEDIATRIC GASTROENTEROLOGY
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE PEDIATRIC GASTROENTEROLOGY
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-3690
  • Fax: 414-266-3676
Mailing address:
  • Phone: 414-266-3690
  • Fax: 414-266-3676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number20667
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: