Provider Demographics
NPI:1316935745
Name:LAI, CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:LAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IN
Mailing Address - Zip Code:46072-9753
Mailing Address - Country:US
Mailing Address - Phone:765-675-8521
Mailing Address - Fax:765-675-8520
Practice Address - Street 1:1000 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-9753
Practice Address - Country:US
Practice Address - Phone:765-675-8521
Practice Address - Fax:765-675-8520
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053876207P00000X
IN01053876A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000603505OtherANTHEM - TIPTON HOSPITAL
IN200323660AMedicaid
940650C3Medicare ID - Type Unspecified
IN000000603505OtherANTHEM - TIPTON HOSPITAL