Provider Demographics
NPI:1285687418
Name:LI, EMILE C (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILE
Middle Name:C
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 1ST AVE S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 1ST AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4300
Practice Address - Country:US
Practice Address - Phone:515-955-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30558207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA35349OtherWELLMARK
IA36166OtherWELLMARK
IAP00041348OtherRR MEDICARE
IA2789OtherMIDLANDS
IA8123083Medicaid
IA2123083Medicaid
IA36166OtherWELLMARK
IA35349OtherWELLMARK
IAP00041348OtherRR MEDICARE