Healthcare Provider Details

I. General information

NPI: 1629166319
Provider Name (Legal Business Name): HSIEN-ELL LAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N WESTWOOD BLVD
POPLAR BLUFF MO
63901-3318
US

IV. Provider business mailing address

2062 CONCORD PL
CAPE GIRARDEAU MO
63701-2506
US

V. Phone/Fax

Practice location:
  • Phone: 573-778-4680
  • Fax:
Mailing address:
  • Phone: 573-339-5799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR6726
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23769
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: