Provider Demographics
NPI:1689745127
Name:SEMBA, LAURA LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LOUISE
Last Name:SEMBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14315 SOUTH 108TH AVENUE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5701
Mailing Address - Country:US
Mailing Address - Phone:708-873-1101
Mailing Address - Fax:708-873-9909
Practice Address - Street 1:14315 SOUTH 108TH AVENUE
Practice Address - Street 2:SUITE 114
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5701
Practice Address - Country:US
Practice Address - Phone:708-873-1101
Practice Address - Fax:708-873-9909
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01608167OtherBCBS INS
IL4526301OtherAETNA INS
E63938Medicare UPIN
946141Medicare ID - Type Unspecified