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General NPI Number Information
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NPI Number | 1679550263
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Entity Type | Individual
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Provider Name | ALLEN QINGJUN LI M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2600 NAVARRE AVE
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City | OREGON
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State | OH
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Zip | 43616-3207
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Country | US
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Telephone | 419-696-7701
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Fax |
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Provider Business Mailing Address
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Address Line | 8701 BIG CYPRESS CIR
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City | SYLVANIA
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State | OH
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Zip | 43560-8919
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Country | US
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Telephone | 419-829-3651
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 35-083649-L
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License Number State | OH
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