Provider Demographics
NPI:1457610503
Name:YILI ZHOU LLC
Entity Type:Organization
Organization Name:YILI ZHOU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YILI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-562-1019
Mailing Address - Street 1:5525 BANANA POINT DR
Mailing Address - Street 2:
Mailing Address - City:OKAHUMPKA
Mailing Address - State:FL
Mailing Address - Zip Code:34762-3334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 W GUAVA ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-1701
Practice Address - Country:US
Practice Address - Phone:352-751-6582
Practice Address - Fax:352-751-6585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104778208100000X
FLME86840208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47853/K8875Medicare UPIN