Provider Demographics
NPI:1568459246
Name:LI, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:LI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:210 JUPITER LAKES BLVD
Mailing Address - Street 2:STE. 5105
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7191
Mailing Address - Country:US
Mailing Address - Phone:561-748-4445
Mailing Address - Fax:561-748-4449
Practice Address - Street 1:210 JUPITER LAKES BLVD
Practice Address - Street 2:STE. 5105
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7191
Practice Address - Country:US
Practice Address - Phone:561-748-4445
Practice Address - Fax:561-748-4449
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2008-01-15
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Provider Licenses
StateLicense IDTaxonomies
FLME0062287207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF40880Medicare UPIN
FL18135YMedicare PIN