Provider Demographics
NPI:1508159435
Name:LI, JACK ZHE (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:ZHE
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:333 N SUMMIT ST FL 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:419-842-3000
Mailing Address - Fax:419-842-3047
Practice Address - Street 1:2940 N MCCORD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1753
Practice Address - Country:US
Practice Address - Phone:419-842-3000
Practice Address - Fax:419-842-3047
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD457147207R00000X, 207RC0000X
MI4301098562207R00000X
OH35.138865207R00000X, 207RC0001X
PAMT207994207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease