Provider Demographics
NPI:1194159012
Name:PRECISION PLASTIC SURGERY, PC ST. LUKES OFFICE
Entity type:Organization
Organization Name:PRECISION PLASTIC SURGERY, PC ST. LUKES OFFICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:LIONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-843-0900
Mailing Address - Street 1:10004 KENNERLY RD
Mailing Address - Street 2:SUITE 260A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2141
Mailing Address - Country:US
Mailing Address - Phone:314-848-0900
Mailing Address - Fax:314-843-0904
Practice Address - Street 1:224 S WOODS MILL RD
Practice Address - Street 2:SUITE 450 SOUTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3451
Practice Address - Country:US
Practice Address - Phone:314-843-0900
Practice Address - Fax:314-843-0904
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRECISION PLASTIC SURGERY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty