Individual
ANITA LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
611 E DOUGLAS RD STE 407, MISHAWAKA, IN 46545-1468
(857) 249-1747
Mailing address
15870 N LAKESHORE DR, GRANGER, IN 46530-7846
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01087618A
IN
207Q00000X
Family Medicine Physician
Primary
09LIA92161
NH
Other
Enumeration date
03/19/2019
Last updated
07/11/2022
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