Provider Demographics
NPI:1437349925
Name:LI, MONA SHIRLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:SHIRLIN
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1155 N MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3462
Mailing Address - Country:US
Mailing Address - Phone:414-955-1050
Mailing Address - Fax:414-955-6457
Practice Address - Street 1:1155 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3462
Practice Address - Country:US
Practice Address - Phone:414-955-1050
Practice Address - Fax:414-955-6457
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390992086S0129X, 208600000X, 2086S0129X
OH35.0968342086S0129X
NY2405622086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1437349925Medicaid
OHH040000Medicare PIN