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NPI Code Detail

MEDICARE: DR. LAWRENCE K.C. LI M.D.

MEDICARE: DR. LAWRENCE K.C. 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
1207X00000XOrthopaedic Surgery PhysicianIL

Other Identifiers

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

General Provider Information

NPI Number : 1164419818
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAWRENCE K.C. LI M.D.
Provider Business Mailing Address
First Line : PO BOX 1645
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61702-1645
Country : US
Telephone Number : 309-454-1616
Fax Number : 309-454-5167
Provider Business Practice Location Address
First Line : 2200 FORT JESSE RD
Second Line : SUITE 250
City : NORMAL
State : IL
Zip : 61761-6286
Country : US
Telephone Number : 309-454-1616
Fax Number : 309-454-5167
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2005
Last Update Date : 07/08/2007

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