=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972540672
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUN LI BM, PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2006
-----------------------------------------------------
Last Update Date | 01/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4201 SAINT ANTOINE ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48201-2153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-745-4275
-----------------------------------------------------
Fax | 313-745-4216
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6560 FANNIN ST FL 8
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-238-8221
-----------------------------------------------------
Fax | 313-745-4216
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | T6946
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 5315171699
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------