Healthcare Provider Details

I. General information

NPI: 1144673856
Provider Name (Legal Business Name): KHENG JOE LAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 GOVERNORS HWY
FLOSSMOOR IL
60422-2125
US

IV. Provider business mailing address

1100 BERGSLIEN ST
BALDWIN WI
54002-2600
US

V. Phone/Fax

Practice location:
  • Phone: 888-824-0200
  • Fax:
Mailing address:
  • Phone: 715-684-1111
  • Fax: 715-684-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.069276
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036181509
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: