Provider Demographics
NPI:1275510174
Name:LI, ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CREDENTIALLING OFFICE
Mailing Address - Street 2:1900 E MAIN ST
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-1000
Mailing Address - Country:US
Mailing Address - Phone:630-456-6292
Mailing Address - Fax:
Practice Address - Street 1:CREDENTIALLING OFFICE
Practice Address - Street 2:1900 E MAIN ST
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-1000
Practice Address - Country:US
Practice Address - Phone:630-456-6292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114306207P00000X, 2083X0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH72906Medicare UPIN
ILF400101392Medicare UPIN