Individual
DR. MENA M LUANGJAMEKORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4 MEMORIAL DR, STE 230, ALTON, IL 62002-6751
(618) 463-7777
(618) 463-7767
Mailing address
670 MASON RIDGE CENTER DR, STE 300, SAINT LOUIS, MO 63141-8573
(618) 463-7777
(618) 463-7767
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036.125173
IL
207Q00000X
Family Medicine Physician
4301076196
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0802510871
BLUE CROSS BLUE SHIELD
MI
01
—
080D410020
BLUE CROSS BLUE SHIELD
MI
01
—
0998002
0998002
MI
01
—
1010621
HEALTH ADVANTAGE NETWORK
MI
01
—
16492
MCARE
MI
01
—
2014164001
CIGNA
MI
05
—
4591430
—
MI
05
—
4619498
—
MI
05
—
4698830
—
MI
01
—
7450589
AETNA
MI
01
—
I07388
HEALTH ALLIANCE PLAN
MI
Enumeration date
10/19/2005
Last updated
11/13/2012
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