Provider Demographics
NPI:1962554758
Name:ST. LUKE'S BREAST CARE CENTER
Entity type:Organization
Organization Name:ST. LUKE'S BREAST CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRAJCOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-205-6491
Mailing Address - Street 1:232 S WOODS MILL RD STE 200E
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3417
Mailing Address - Country:US
Mailing Address - Phone:314-205-6491
Mailing Address - Fax:314-205-6492
Practice Address - Street 1:232 S WOODS MILL RD STE 200E
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3417
Practice Address - Country:US
Practice Address - Phone:314-205-6491
Practice Address - Fax:314-205-6492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO27431174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty