Provider Demographics
NPI:1588240022
Name:LI, ANQI (DO)
Entity Type:Individual
Prefix:
First Name:ANQI
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 FOREST GLEN DR APT L
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8034
Mailing Address - Country:US
Mailing Address - Phone:857-231-6782
Mailing Address - Fax:
Practice Address - Street 1:7702 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-3107
Practice Address - Country:US
Practice Address - Phone:815-971-3397
Practice Address - Fax:815-971-9795
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL1588240022390200000X
IL036.167885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program