Basic Information
Provider Information
NPI: 1003293036
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LI
FirstName: RENJIE
MiddleName: MICHAEL
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: LI
OtherFirstName: MICHAEL
OtherMiddleName: RENJIE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: MD
OtherLastNameType: 5
Mailing Information
Address1: 13737 NOEL RD
Address2:  
City: DALLAS
State: TX
PostalCode: 752401331
CountryCode: US
TelephoneNumber: 2142171912
FaxNumber:  
Practice Location
Address1: 13737 NOEL RD
Address2:  
City: DALLAS
State: TX
PostalCode: 75240
CountryCode: US
TelephoneNumber: 2142171912
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/28/2015
LastUpdateDate: 07/20/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XR6434TXY Allopathic & Osteopathic PhysiciansEmergency Medicine 
207P00000XA144807CAN Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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