Provider Demographics
NPI:1396810644
Name:LI, XIAOLU (SHERRY) (MD)
Entity type:Individual
Prefix:DR
First Name:XIAOLU (SHERRY)
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 1:909 E GRANT ST
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-3371
Mailing Address - Country:US
Mailing Address - Phone:309-837-2000
Mailing Address - Fax:309-837-2272
Practice Address - Street 1:909 E GRANT ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3371
Practice Address - Country:US
Practice Address - Phone:309-837-2000
Practice Address - Fax:309-837-2272
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05532018OtherBLUE CROSS BLUE SHEILD
IL211285Medicare ID - Type Unspecified
ILG85626Medicare UPIN