Individual
STACIE LAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4600 MEMORIAL DR STE 280, BELLEVILLE, IL 62226-5363
(618) 257-2800
(618) 257-9802
Mailing address
4600 MEMORIAL DR STE 280, BELLEVILLE, IL 62226-5363
(618) 257-2800
(618) 257-9802
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-092496
IL
208000000X
Pediatrics Physician
103954
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036092496-2
—
IL
05
—
036092496-3
—
IL
Enumeration date
07/17/2006
Last updated
03/18/2013
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