Individual
LI SONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4206 PONTIAC LAKE RD, WATERFORD, MI 48328-1261
(248) 742-1638
(248) 742-1654
Mailing address
4206 PONTIAC LAKE RD, WATERFORD, MI 48328-1261
(248) 742-1638
(248) 742-1654
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
4704261932
MI
363LF0000X
Family Nurse Practitioner
4704261932
MI
363LP2300X
Primary Care Nurse Practitioner
Primary
4704261932
MI
Other
Enumeration date
02/11/2015
Last updated
08/05/2025
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