Provider Demographics
NPI:1790137172
Name:LI, DEBBIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBBIE
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 1:420 DELAWARE STREET SE, MMC 195
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-301-9433
Mailing Address - Fax:612-625-4411
Practice Address - Street 1:420 DELAWARE STREET SE, MMC 195
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-301-9433
Practice Address - Fax:612-625-4411
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program