MEDICARE: STACIE LAFF M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036-092496	IL
2	208000000X	Pediatrics Physician	103954	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851318489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACIE LAFF M.D.

Provider Business Mailing Address
First Line	:	4600 MEMORIAL DR STE 280
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5363
Country	:	US
Telephone Number	:	618-257-2800
Fax Number	:	618-257-9802

Provider Business Practice Location Address
First Line	:	4600 MEMORIAL DR STE 280
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5363
Country	:	US
Telephone Number	:	618-257-2800
Fax Number	:	618-257-9802

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/18/2013

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Directions to “ STACIE LAFF M.D.” Practice Location

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