Provider Demographics
NPI:1578672614
Name:CAYABYAB-LOE, LILIBETH
Entity Type:Individual
Prefix:
First Name:LILIBETH
Middle Name:
Last Name:CAYABYAB-LOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-996-5900
Mailing Address - Fax:314-996-5910
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:SUITE 387C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-996-5900
Practice Address - Fax:314-996-5910
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4P60207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203679253Medicaid
MO203679253Medicaid
MO009012630Medicare ID - Type Unspecified