Healthcare Provider Details

I. General information

NPI: 1255747119
Provider Name (Legal Business Name): LEAH BRANCHECK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SAINT LUKES CENTER DR STE 20B
CHESTERFIELD MO
63017-3509
US

IV. Provider business mailing address

111 SAINT LUKES CENTER DR STE 20B
CHESTERFIELD MO
63017-3509
US

V. Phone/Fax

Practice location:
  • Phone: 636-685-7745
  • Fax:
Mailing address:
  • Phone: 636-685-7745
  • Fax: 314-576-8167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2017038573
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: