Healthcare Provider Details

I. General information

NPI: 1184728784
Provider Name (Legal Business Name): PRECISION PLASTIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S WOODS MILL RD SUITE 450 SOUTH
CHESTERFIELD MO
63017-3513
US

IV. Provider business mailing address

680 CRAIG RD SUITE 304-A
SAINT LOUIS MO
63141-7120
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2002010424
License Number StateMO

VIII. Authorized Official

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