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General NPI Number Information
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NPI Number | 1235407982
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Entity Type | Organization
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Legal Business Name | BERNARDO F LI MD GARDENIA J PAJUNAR-LI MD LTD
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Dates
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Enumeration Date | 12/09/2011
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 11309 S MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60628-4911
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Country | US
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Telephone | 773-264-2020
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Fax | 773-264-7960
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Provider Business Mailing Address
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Address Line | 11309 S MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60628-4911
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Country | US
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Telephone | 773-264-2020
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Fax | 773-264-7960
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BERNARDO LI
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Credential | M.D.
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Telephone | 773-264-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036052771
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License Number State | IL
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