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NPI Code Detail

MEDICARE: ST. LUKE'S FAMILY MEDICINE - MARYLAND HEIGHTS LLC

MEDICARE: ST. LUKE'S FAMILY MEDICINE - MARYLAND HEIGHTS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1902197767
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. LUKE'S FAMILY MEDICINE - MARYLAND HEIGHTS LLC
Provider Business Mailing Address
First Line : 915 FEE FEE RD
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-3801
Country : US
Telephone Number : 314-770-1777
Fax Number : 314-770-1776
Provider Business Practice Location Address
First Line : 915 FEE FEE RD
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-3801
Country : US
Telephone Number : 314-770-1777
Fax Number : 314-590-5952
Authorized Official
Title or Position : CHIEF MEDICAL OFFICER
Name : MR. DARREN HASKELL
Credential : MD.
Telephone Number : 314-205-6444
Provider Enumeration Date : 04/28/2011
Last Update Date : 03/05/2026

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