Provider Demographics
NPI:1376725143
Name:LI, TAO (MD)
Entity Type:Individual
Prefix:DR
First Name:TAO
Middle Name:
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 1:3585 N UNIVERSITY AVE
Mailing Address - Street 2:STE #150
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6601
Mailing Address - Country:US
Mailing Address - Phone:801-356-6100
Mailing Address - Fax:801-356-2113
Practice Address - Street 1:3585 N UNIVERSITY AVE
Practice Address - Street 2:STE #150
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6601
Practice Address - Country:US
Practice Address - Phone:801-356-6100
Practice Address - Fax:801-356-2113
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6719045208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine