Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 6374 | NE |
N | 208600000X | Surgeon | 6374 | NE |
N | 2086S0127X | Trauma Surgeon | 036.142360 | IL |
Y | 2086S0127X | Trauma Surgeon | 2021013820 | MO |
NPI | 1235447368 |
---|---|
Provider Name | Kulsoom Laeeq |
First Address | Saint Louis, MO 63141-8261 |
Second Address | Saint Louis, MO 63141-8261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2010 |
Last Update Date | 02/08/2021 |