Provider Demographics
NPI:1255320578
Name:LUANGJAMEKORN, MENA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MENA
Middle Name:M
Last Name:LUANGJAMEKORN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:618-463-7777
Mailing Address - Fax:618-463-7767
Practice Address - Street 1:4 MEMORIAL DR
Practice Address - Street 2:STE 230
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6751
Practice Address - Country:US
Practice Address - Phone:618-463-7777
Practice Address - Fax:618-463-7767
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2012-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301076196207Q00000X
IL036.125173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4591430Medicaid
MII07388OtherHEALTH ALLIANCE PLAN
MI1010621OtherHEALTH ADVANTAGE NETWORK
MI4619498Medicaid
MI7450589OtherAETNA
MI080D410020OtherBLUE CROSS BLUE SHIELD
MI16492OtherMCARE
MI080D410020OtherBLUE CARE NETWORK
MI1010621OtherMCLAREN HEALTH PLAN
MI0802510871OtherBLUE CROSS BLUE SHIELD
MII07388OtherHEALTH NET FEDERAL
MI2014164001OtherCIGNA
MI0998002Other0998002
MI0998002OtherGENESEE HEALTH PLAN
MI4698830Medicaid
MI1010621OtherHEALTH ADVANTAGE NETWORK
MI080D410020OtherBLUE CARE NETWORK
MI0998002Other0998002