Provider Demographics
NPI:1235407982
Name:BERNARDO F LI MD GARDENIA J PAJUNAR-LI MD LTD
Entity Type:Organization
Organization Name:BERNARDO F LI MD GARDENIA J PAJUNAR-LI MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-264-2020
Mailing Address - Street 1:11309 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4911
Mailing Address - Country:US
Mailing Address - Phone:773-264-2020
Mailing Address - Fax:773-264-7960
Practice Address - Street 1:11309 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4911
Practice Address - Country:US
Practice Address - Phone:773-264-2020
Practice Address - Fax:773-264-7960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052771261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL485430Medicare UPIN