Provider Demographics
NPI:1861454035
Name:LI, YU JIM (MD)
Entity Type:Individual
Prefix:
First Name:YU
Middle Name:JIM
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-2917
Mailing Address - Country:US
Mailing Address - Phone:309-762-8555
Mailing Address - Fax:309-736-0733
Practice Address - Street 1:1520 7TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-2917
Practice Address - Country:US
Practice Address - Phone:309-762-8555
Practice Address - Fax:309-736-0733
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47029207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34560500Medicaid
WI34560500Medicaid
I15768Medicare UPIN