Provider Demographics
NPI:1235322512
Name:MING-LUM, COREY N (MD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:N
Last Name:MING-LUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7425 FORSYTH
Mailing Address - Street 2:C B 8221
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2161
Mailing Address - Country:US
Mailing Address - Phone:314-747-3969
Mailing Address - Fax:314-454-8887
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:8TH FLOOR SUITE C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-3969
Practice Address - Fax:314-454-8887
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2008-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2007023408208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000225Medicare UPIN