Luangjamekorn, Mena M

Luangjamekorn, Mena M is an individual health care provider with primary practice located at 4 Memorial Dr Ste 230, Alton IL 62002-6751. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Luangjamekorn, Mena M can be contacted via phone (618) 463-7777.

Contact Information

Primary practice address
4 Memorial Dr Ste 230 Alton IL 62002-6751
Phone: (618) 463-7777
Fax: (618) 463-7767
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 4301076196 Michigan
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036.125173 Illinois

Profile Details

NPI number 1255320578
LBN Legal business name Luangjamekorn, Mena M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 19th, 2005
Last updated Nov 13th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255320578 NPPES
Michigan MEDICAID 4591430
Michigan Other I07388
Michigan Other 1010621
Michigan MEDICAID 4619498
Michigan Other 7450589
Michigan Other 080D410020
Michigan Other 16492
Michigan Other 080D410020
Michigan Other 1010621
Michigan Other 0802510871
Michigan Other I07388
Michigan Other 2014164001
Michigan Other 0998002
Michigan Other 0998002
Michigan MEDICAID 4698830

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