Provider Demographics
NPI:1144844564
Name:LI, ELTON YICHAO (MD)
Entity type:Individual
Prefix:DR
First Name:ELTON
Middle Name:YICHAO
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 902
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-0902
Mailing Address - Country:US
Mailing Address - Phone:731-358-6654
Mailing Address - Fax:423-225-8189
Practice Address - Street 1:102 N. SUPERIOR AVENUE
Practice Address - Street 2:
Practice Address - City:BARAGA
Practice Address - State:MI
Practice Address - Zip Code:49908
Practice Address - Country:US
Practice Address - Phone:906-353-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036174328207Q00000X
MI4351046940390200000X
MI4301510061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty