Provider Demographics
NPI:1275503971
Name:LI, MARY M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:LI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:ATTN: CREDENTIAL DEPT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:7154 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-1329
Practice Address - Country:US
Practice Address - Phone:352-596-1926
Practice Address - Fax:352-597-2154
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-08-10
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Provider Licenses
StateLicense IDTaxonomies
FLME84859207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00468395OtherRAILROAD MEDICARE
FL265504700Medicaid
FL13626XMedicare PIN
FL13626YMedicare PIN
FL265504700Medicaid