Provider Demographics
NPI:1023758380
Name:LI, MICHAEL (MD, PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LI
Suffix:
Gender:
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF INTERNAL MEDICINE
Mailing Address - Street 2:HEALTH SCIENCE CENTER T16, ROOM 020 101 NICOLLS RD
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794
Mailing Address - Country:US
Mailing Address - Phone:631-444-7411
Mailing Address - Fax:631-444-2493
Practice Address - Street 1:DEPARTMENT OF INTERNAL MEDICINE
Practice Address - Street 2:HEALTH SCIENCE CENTER T16, ROOM 020 101 NICOLLS RD
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794
Practice Address - Country:US
Practice Address - Phone:631-444-7411
Practice Address - Fax:631-444-2493
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA201188207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine