Individual
PAUL K LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3105 FIELDS SOUTH DR, CHAMPAIGN, IL 61822-3743
(217) 902-7527
(217) 902-7755
Mailing address
611 W PARK ST, BWPC, URBANA, IL 61801-2529
(217) 383-6792
(217) 383-4752
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
036129123
IL
2086S0122X
Plastic and Reconstructive Surgery Physician
01065914A
IN
2086S0122X
Plastic and Reconstructive Surgery Physician
37821
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000596754
ANTHEM PROVIDER NUMBER
IN
05
—
200928690
—
IN
05
—
34055400
—
WI
Enumeration date
08/31/2006
Last updated
04/23/2019
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