Healthcare Provider Details

I. General information

NPI: 1134188428
Provider Name (Legal Business Name): ELIZABETH LEE SOMSEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W LOSEY ST
SCOTT AFB IL
62225-5250
US

IV. Provider business mailing address

310 W LOSEY ST
SCOTT AFB IL
62225-5250
US

V. Phone/Fax

Practice location:
  • Phone: 618-229-6231
  • Fax:
Mailing address:
  • Phone: 618-229-6231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2006007051
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: