Provider Demographics
NPI:1114901725
Name:LAI, LI LING (MD)
Entity Type:Individual
Prefix:
First Name:LI LING
Middle Name:
Last Name:LAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 UNITED DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-7428
Mailing Address - Country:US
Mailing Address - Phone:618-855-9041
Mailing Address - Fax:618-855-9046
Practice Address - Street 1:101 UNITED DR
Practice Address - Street 2:SUITE 110
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-7428
Practice Address - Country:US
Practice Address - Phone:618-855-9041
Practice Address - Fax:618-855-9046
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036120859208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036120859Medicaid
MN707668100Medicaid
MN707668100Medicaid
IL036120859Medicaid