Provider Demographics
NPI:1629085022
Name:LAI, PETER PINGKWONG (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:PINGKWONG
Last Name:LAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 NAPIER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2112
Mailing Address - Country:US
Mailing Address - Phone:269-983-8888
Mailing Address - Fax:
Practice Address - Street 1:520 S 7TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1038
Practice Address - Country:US
Practice Address - Phone:812-885-3939
Practice Address - Fax:812-885-3974
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV276992085R0001X
MI43010775062085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI320A111090OtherBCBS PROVIDER NUMBER
MI320A111090OtherBCBS PROVIDER NUMBER
MIB18542Medicare UPIN
MI383592122OtherTAX ID NUMBER
MIN30570001Medicare ID - Type Unspecified