Provider Demographics
NPI:1346359387
Name:LI, MAUREEN (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 MONTGOMERY RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2198
Mailing Address - Country:US
Mailing Address - Phone:513-961-5558
Mailing Address - Fax:513-961-1912
Practice Address - Street 1:320 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3410
Practice Address - Country:US
Practice Address - Phone:859-341-4266
Practice Address - Fax:859-341-9532
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0784562084N0400X
KY378472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
05-00740OtherUNITED HEALTHCARE
KY64036882Medicaid
000000194546OtherANTHEM
OH2280231Medicaid
3301943-001OtherCIGNA
IN200341570AMedicaid
2572013OtherAETNA
311412447042OtherCARESOURCE
IN200341570AMedicaid
3301943-001OtherCIGNA
05-00740OtherUNITED HEALTHCARE
IN200341570AMedicaid