Provider Demographics
NPI:1386687150
Name:LI, BO CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:BO
Middle Name:CHARLES
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7705 POPLAR AVENUE, SUITE 240
Mailing Address - Street 2:PROFESSIONAL BLDG. B
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-791-9800
Mailing Address - Fax:901-791-9801
Practice Address - Street 1:7705 POPLAR AVENUE, SUITE 240
Practice Address - Street 2:PROFESSIONAL BLDG. B
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-791-9800
Practice Address - Fax:901-791-9801
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD37698207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH91266Medicare PIN
H91266Medicare UPIN
TN3885860Medicare UPIN
TN3885860Medicare PIN