Provider Demographics
NPI:1750104097
Name:LI, SHIBO
Entity type:Individual
Prefix:
First Name:SHIBO
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12705 E MONTVIEW BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7112
Mailing Address - Country:US
Mailing Address - Phone:303-724-5701
Mailing Address - Fax:303-724-5795
Practice Address - Street 1:12705 E MONTVIEW BLVD STE 400
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7112
Practice Address - Country:US
Practice Address - Phone:303-724-5701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO96113CYT207SC0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics