Healthcare Provider Details

I. General information

NPI: 1114901725
Provider Name (Legal Business Name): LI LING LAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 UNITED DR SUITE 110
COLLINSVILLE IL
62234-7428
US

IV. Provider business mailing address

101 UNITED DR SUITE 110
COLLINSVILLE IL
62234-7428
US

V. Phone/Fax

Practice location:
  • Phone: 618-855-9041
  • Fax: 618-855-9046
Mailing address:
  • Phone: 618-855-9041
  • Fax: 618-855-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036120859
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: