Provider Demographics
NPI:1740521467
Name:CURTIS K. LI, MD, PC
Entity type:Organization
Organization Name:CURTIS K. LI, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:K
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-234-8877
Mailing Address - Street 1:1300 E A ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2260
Mailing Address - Country:US
Mailing Address - Phone:307-234-8877
Mailing Address - Fax:307-266-4285
Practice Address - Street 1:1300 E A ST
Practice Address - Street 2:SUITE 209
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2260
Practice Address - Country:US
Practice Address - Phone:307-234-8877
Practice Address - Fax:307-266-4285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5572A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY109705900Medicaid
WY109705900Medicaid
WYA51516Medicare UPIN