Provider Demographics
NPI:1598723975
Name:LI, EILEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W 5TH ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5034
Mailing Address - Country:US
Mailing Address - Phone:432-332-7337
Mailing Address - Fax:432-332-9264
Practice Address - Street 1:540 W 5TH ST
Practice Address - Street 2:SUITE 360
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5034
Practice Address - Country:US
Practice Address - Phone:432-332-7337
Practice Address - Fax:432-332-9264
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1882208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180422101Medicaid
TX180422101Medicaid
TX8F3066Medicare PIN