Healthcare Provider Details

I. General information

NPI: 1194354555
Provider Name (Legal Business Name): CRISTIAN MICHAEL LAMMOGLIA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 DE PAUL DR
BRIDGETON MO
63044-2512
US

IV. Provider business mailing address

333 MULHOLLAND DR APT 553
SAINT CHARLES MO
63303-4358
US

V. Phone/Fax

Practice location:
  • Phone: 314-344-6000
  • Fax:
Mailing address:
  • Phone: 816-244-9579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number59.000827
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: