Organization
TLC PEDIATRICS LTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACIE SHARON LAFF MD (PRESIDENT)
(618) 257-9814
Entity
Organization
Contact information
Practice address
4600 MEMORIAL DR, STE 280, BELLEVILLE, IL 62226-5366
(618) 257-9814
(618) 257-9802
Mailing address
4600 MEMORIAL DR, STE 280, BELLEVILLE, IL 62226-5366
(618) 257-9814
(618) 257-9802
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036092496
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08232033
BCBS OF IL
—
Enumeration date
12/04/2006
Last updated
12/02/2013
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