Provider Demographics
NPI:1669409678
Name:LI, CURTIS K (MD PC)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:K
Last Name:LI
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E A ST STE 209
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2252
Mailing Address - Country:US
Mailing Address - Phone:307-234-8877
Mailing Address - Fax:307-266-4285
Practice Address - Street 1:415 6TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2434
Practice Address - Country:US
Practice Address - Phone:208-750-7507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5572A174400000X
IDMC-0034174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
060052207OtherRR MEDICARE
WY304747OtherBLUE SHIELD
WY109705900Medicaid
WY304747OtherBLUE SHIELD