MEDICARE: DR. JOHN 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
1	207YX0901X	Otology & Neurotology Physician	ME0062287	FL

General Provider Information

NPI Number	:	1568459246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN C LI M.D.

Provider Business Mailing Address
First Line	:	210 JUPITER LAKES BLVD
Second Line	:	STE. 5105
City	:	JUPITER
State	:	FL
Zip	:	33458-7191
Country	:	US
Telephone Number	:	561-748-4445
Fax Number	:	561-748-4449

Provider Business Practice Location Address
First Line	:	210 JUPITER LAKES BLVD
Second Line	:	STE. 5105
City	:	JUPITER
State	:	FL
Zip	:	33458-7191
Country	:	US
Telephone Number	:	561-748-4445
Fax Number	:	561-748-4449

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	01/15/2008

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Directions to “ DR. JOHN C LI M.D.” Practice Location

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