=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255415980
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEANNE FARLEY-LI MD SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 530 WINNETKA AVE
-----------------------------------------------------
City | WINNETKA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60093-4023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-441-6868
-----------------------------------------------------
Fax | 847-441-6895
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 530 WINNETKA AVE
-----------------------------------------------------
City | WINNETKA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60093-4023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-441-6868
-----------------------------------------------------
Fax | 847-441-6895
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JEANNE ELIZABETH FARLEY-LI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 847-441-6868
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------