Individual
PAN LI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-2000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110011282
VA
363A00000X
Physician Assistant
033377-01
NY
363A00000X
Physician Assistant
085011036
IL
363A00000X
Physician Assistant
14195522-1206
UT
363A00000X
Physician Assistant
5601012921
MI
363A00000X
Physician Assistant
66258
CA
363A00000X
Physician Assistant
Primary
8146-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100297874
—
WI
Enumeration date
08/01/2024
Last updated
09/26/2025
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