Individual
DR. FANG LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2204 EASTLAND DR, BLOOMINGTON, IL 61704-3566
(309) 662-9461
(309) 663-0222
Mailing address
2204 EASTLAND DR, BLOOMINGTON, IL 61704-3566
(309) 662-9461
(309) 663-0222
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036095578
IL
2084N0400X
Neurology Physician
Primary
036095578
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036095578
—
IL
01
—
130016944
MEDICARE ID
IL
01
—
5715381
BLUE CROSS BLUE SHIELD
IL
Enumeration date
09/15/2006
Last updated
04/01/2025
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