Provider Demographics
NPI:1477676831
Name:LAI, MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:QUYNH CHI
Other - Last Name:LAI-VELEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M D
Mailing Address - Street 1:6855 LINCOLN ROAD EXT
Mailing Address - Street 2:STE 50
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3271
Mailing Address - Country:US
Mailing Address - Phone:601-336-7700
Mailing Address - Fax:888-655-7513
Practice Address - Street 1:6855 LINCOLN ROAD EXT
Practice Address - Street 2:STE 50
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3271
Practice Address - Country:US
Practice Address - Phone:601-336-7700
Practice Address - Fax:888-655-7513
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98167207R00000X, 208000000X
CAA99890207R00000X, 208000000X
MS20803207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSLUMBERTON - 1148998OtherWINDSOR HEALTH GROUP
MS452047551001OtherTRICARE
MS44449960P01OtherCIGNA
MS9665147OtherAETNA
MS03109592Medicaid
MS2918535OtherUNITED HEALTH CARE
MS452047551001OtherTRICARE