Provider Demographics
NPI:1730122748
Name:LI, XIAO RUI (MD)
Entity Type:Individual
Prefix:DR
First Name:XIAO
Middle Name:RUI
Last Name:LI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:7905 CALUMET AVE
Practice Address - Street 2:HAMMOND CLINIC LLC
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1215
Practice Address - Country:US
Practice Address - Phone:219-836-7214
Practice Address - Fax:219-836-4678
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-03-20
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Provider Licenses
StateLicense IDTaxonomies
IN01055296A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200358670Medicaid
IN473060P4OtherMEDICARE
IN473060P4OtherMEDICARE