Li, Fang

Li, Fang is an individual health care provider with primary practice located at 2204 Eastland Dr , Bloomington IL 61704-3566. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Li, Fang can be contacted via phone (309) 662-9461.

Contact Information

Primary practice address
2204 Eastland Dr Bloomington IL 61704-3566
Phone: (309) 662-9461
Fax: (309) 663-0222
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 036095578 Illinois

Profile Details

NPI number 1356447841
LBN Legal business name Li, Fang
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 15th, 2006
Last updated May 21st, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356447841 NPPES
Illinois Other 130016944 MEDICARE ID
Illinois MEDICAID 036095578 MEDICARE ID
Illinois Other 5715381 MEDICARE ID

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