Provider Demographics
NPI:1013946821
Name:LI MBU, INDRA P
Entity Type:Individual
Prefix:
First Name:INDRA
Middle Name:P
Last Name:LI MBU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 PARMALEE AVE
Mailing Address - Street 2:STE. 610
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1716
Mailing Address - Country:US
Mailing Address - Phone:330-744-4369
Mailing Address - Fax:330-744-1728
Practice Address - Street 1:540 PARMALEE AVE
Practice Address - Street 2:STE. 610
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1716
Practice Address - Country:US
Practice Address - Phone:330-744-4369
Practice Address - Fax:330-744-1728
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-87246207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease