Provider Demographics
NPI:1366483570
Name:LI, GUANG H (MD)
Entity Type:Individual
Prefix:
First Name:GUANG
Middle Name:H
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 1:2600 NAVARRE AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3207
Mailing Address - Country:US
Mailing Address - Phone:419-696-7701
Mailing Address - Fax:419-696-7866
Practice Address - Street 1:1900 S. MAIN ST. BLANCHARD VALLE HOSPITAL
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840
Practice Address - Country:US
Practice Address - Phone:419-423-5301
Practice Address - Fax:419-696-7866
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082938207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2418815Medicaid
OH000000292629OtherBCBS
OH2418815Medicaid
OH000000292629OtherBCBS
OHLI4112161Medicare ID - Type Unspecified