Individual
DR. CHANGXIN LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
829 N CENTER AVE, SUITE 140, GAYLORD, MI 49735-1595
(989) 731-7870
(989) 731-7837
Mailing address
829 N CENTER AVE, SUITE 298, GAYLORD, MI 49735-1595
(989) 731-7708
(989) 731-7929
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301058124
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1106900352
BCBSM PROVIDER NUMBER
MI
01
—
11281960
CAQH PROVIDER ID
—
01
—
381303843
TAX ID
—
05
—
4299165
—
MI
01
—
DC6209
MEDICARE RR PROV ID
—
Enumeration date
07/05/2006
Last updated
12/03/2013
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