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General NPI Number Information
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NPI Number | 1649582628
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Entity Type | Individual
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Provider Name | JOE LI DPM
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Gender | Male
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Dates
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Enumeration Date | 07/07/2010
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 4877 PALM COAST PKWY NW UNIT 4
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City | PALM COAST
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State | FL
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Zip | 32137-3677
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Country | US
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Telephone | 386-490-9990
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Fax | 386-263-8768
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Provider Business Mailing Address
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Address Line | 4877 PALM COAST PKWY NW UNIT 4
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City | PALM COAST
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State | FL
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Zip | 32137-3677
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Country | US
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Telephone | 386-490-9990
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Fax | 386-263-8768
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901002370
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3598
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License Number State | FL
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