Provider Demographics
NPI:1568415263
Name:LI, JESSE Z (MD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:Z
Last Name:LI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1100 SOUTHFIELD DR
Mailing Address - Street 2:SUITE 1370
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4498
Mailing Address - Country:US
Mailing Address - Phone:317-837-5571
Mailing Address - Fax:317-837-5580
Practice Address - Street 1:100 HOSPITAL LN
Practice Address - Street 2:SUITE 225
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1989
Practice Address - Country:US
Practice Address - Phone:317-718-4730
Practice Address - Fax:317-718-4733
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-12-09
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Provider Licenses
StateLicense IDTaxonomies
IN01052541A2084S0012X
IN010525412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200267720Medicaid
IN354590LLMedicare PIN
IN200267720Medicaid