Individual
LI LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12751 WESTLINKS DR, UNIT 3, FORT MYERS, FL 33913-8615
(239) 561-9622
(239) 768-5297
Mailing address
4371 VERONICA S SHOEMAKER BLVD, ATTN: CREDENTIAL DEPARTMENT, FORT MYERS, FL 33916-2216
(239) 274-8200
(239) 278-3350
Taxonomy
Speciality
Code
Description
License number
State
207ZH0000X
Hematology (Pathology) Physician
Primary
ME112627
FL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
ME112627
FL
390200000X
Student in an Organized Health Care Education/Training Program
62621
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005485000
—
FL
01
—
62621
AMC
NY
Enumeration date
10/09/2008
Last updated
08/04/2023
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