Provider Demographics
NPI:1568579043
Name:LI-CONRAD, JANE ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ELIZABETH
Last Name:LI-CONRAD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:E
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 714328
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-4328
Mailing Address - Country:US
Mailing Address - Phone:216-261-7970
Mailing Address - Fax:216-261-6191
Practice Address - Street 1:26151 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3322
Practice Address - Country:US
Practice Address - Phone:216-261-7970
Practice Address - Fax:216-261-6191
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-006036207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2073808Medicaid
OH029390Medicare PIN
SC7025Medicare PIN
SC7108Medicare PIN
H02719Medicare UPIN
SC012195Medicaid
SC6315Medicare PIN
SC7043Medicare PIN