Provider Demographics
NPI:1548280092
Name:YILI ZHOU LLC
Entity type:Organization
Organization Name:YILI ZHOU LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YILI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-331-0909
Mailing Address - Street 1:5525 BANANA POINT DR
Mailing Address - Street 2:
Mailing Address - City:OKAHUMPKA
Mailing Address - State:FL
Mailing Address - Zip Code:34762-3334
Mailing Address - Country:US
Mailing Address - Phone:352-331-0909
Mailing Address - Fax:352-331-0970
Practice Address - Street 1:6830 NW 11TH PL
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4254
Practice Address - Country:US
Practice Address - Phone:352-331-0909
Practice Address - Fax:352-331-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86840208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00264488/DD9858OtherRAILROAD MEDICARE
FL265587000Medicaid
FL265587001Medicaid
FL287725OtherAVMED
FL47853OtherBCBS
FL7281245OtherAETNA
FL=========OtherBEECHSTREET
P00264488/DD9858OtherRAILROAD MEDICARE
FL265587000Medicaid
FL=========OtherTRI CARE
FL265587000Medicaid
K8875Medicare PIN
FL287725OtherAVMED