MEDICARE: DR. CHANGXIN 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	207R00000X	Internal Medicine Physician	4301058124	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC6209	OTHER		MEDICARE RR PROV ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1106900352	OTHER	MI	BCBSM PROVIDER NUMBER
3	11281960	OTHER		CAQH PROVIDER ID
4	381303843	OTHER		TAX ID
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114958899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANGXIN LI M.D.

Provider Business Mailing Address
First Line	:	829 N CENTER AVE
Second Line	:	SUITE 298
City	:	GAYLORD
State	:	MI
Zip	:	49735-1595
Country	:	US
Telephone Number	:	989-731-7708
Fax Number	:	989-731-7929

Provider Business Practice Location Address
First Line	:	829 N CENTER AVE
Second Line	:	SUITE 140
City	:	GAYLORD
State	:	MI
Zip	:	49735-1595
Country	:	US
Telephone Number	:	989-731-7870
Fax Number	:	989-731-7837

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	12/03/2013

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Directions to “ DR. CHANGXIN LI M.D.” Practice Location

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