MEDICARE: DR. BERNARDO FERNANDO LI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	036-052771	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083779300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNARDO FERNANDO LI M.D.

Provider Business Mailing Address
First Line	:	11309 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-4911
Country	:	US
Telephone Number	:	773-264-2020
Fax Number	:	773-264-7960

Provider Business Practice Location Address
First Line	:	11309 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-4911
Country	:	US
Telephone Number	:	773-264-2020
Fax Number	:	773-264-7960

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	02/07/2017

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Directions to “ DR. BERNARDO FERNANDO LI M.D.” Practice Location

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