Provider Demographics
NPI:1700802311
Name:DUAN, NAILI (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:NAILI
Middle Name:
Last Name:DUAN
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9730 COMMERCE CENTER CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3615
Mailing Address - Country:US
Mailing Address - Phone:239-590-9190
Mailing Address - Fax:239-989-0166
Practice Address - Street 1:9730 COMMERCE CENTER CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3615
Practice Address - Country:US
Practice Address - Phone:239-590-9190
Practice Address - Fax:239-989-0166
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME879542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00162627OtherRAILROAD MEDICARE
FL201237231OtherTAX ID
FL270191000Medicaid
FLME87954OtherLICENSE
FLME87954OtherLICENSE
FL37865AMedicare PIN
FL270191000Medicaid
FLI08103Medicare UPIN