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George Gang Li

Specialist

Other Service Providers

4161 Tamiami Trl, Suite 201, Port Charlotte, FL 33952-9204

PECOS Enrollment

This provider is enrolled in PECOS as GEORGE LI.

Based on the most recent information from CMS, provider George Gang Li is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:30 PM.

Profile Details

Provider ID
1871668368
Provider Type
Individual
Full Name
Li, George Gang
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
11/21/2006
Last Updated
6/22/2010

Contact Information

Practice Location

4161 Tamiami Trl, Suite 201, Port Charlotte, FL 33952-9204

(941) 764-0800

(941) 764-6494

Mailing Location

4161 Tamiami Trl, Suite 201, Port Charlotte, FL 33952-9204

(941) 764-0800

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 174400000X Primary	Description Specialist Other Service Providers	License ME99150 Florida

Provider Identifiers

ID	Description	Issuer
ID 291084500	Description Medicaid	Issuer Unlisted Florida
ID 279901400	Description Medicaid	Issuer Unlisted Florida

George Gang Li

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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ID

Description

Issuer

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