Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 036-110032 | IL |
NPI | 1144282484 |
---|---|
Provider Name | Lisa Lau |
First Address | Chicago, IL 60612-3276 |
Second Address | Chicago, IL 60612-3276 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 13/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I02282 | (02) | IL |