Provider Demographics
NPI:1548610397
Name:QI, OWEN LI (MD)
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:LI
Last Name:QI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OWEN
Other - Middle Name:
Other - Last Name:QI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:759 45TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2939
Mailing Address - Country:US
Mailing Address - Phone:219-922-6226
Mailing Address - Fax:219-922-8784
Practice Address - Street 1:759 45TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2939
Practice Address - Country:US
Practice Address - Phone:219-922-6226
Practice Address - Fax:219-922-8784
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN68338207W00000X
IN01086159A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty