Individual
MU LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(920) 288-4180
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
271030
MA
207RH0003X
Hematology & Oncology Physician
Primary
81925
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100240287
—
WI
Enumeration date
06/18/2017
Last updated
08/16/2023
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