Organization
WESTERN ILLINOIS MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. XIAOLU LI M.D. (PHYSICIAN)
(309) 837-7546
Entity
Organization
Contact information
Practice address
909 E GRANT ST, MACOMB, IL 61455-3371
(309) 837-7546
(312) 674-7546
Mailing address
909 E GRANT ST, MACOMB, IL 61455-3371
(309) 837-7546
(126) 747-5463
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207Q00000X
Family Medicine Physician
036099467
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039099467
—
IL
01
—
05532018
BLUE CROSS BLUE SHEILD
IL
Enumeration date
04/04/2007
Last updated
01/18/2023
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