Healthcare Provider Details

I. General information

NPI: 1194159012
Provider Name (Legal Business Name): PRECISION PLASTIC SURGERY, PC ST. LUKES OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S WOODS MILL RD SUITE 450 SOUTH
CHESTERFIELD MO
63017-3451
US

IV. Provider business mailing address

10004 KENNERLY RD SUITE 260A
SAINT LOUIS MO
63128-2141
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-0900
  • Fax: 314-843-0904
Mailing address:
  • Phone: 314-848-0900
  • Fax: 314-843-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. GERALD T LIONELLI
Title or Position: OWNER
Credential: M.D.
Phone: 314-843-0900