Healthcare Provider Details

I. General information

NPI: 1124092788
Provider Name (Legal Business Name): LORENA BUFFA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 04/18/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 VETERANS MEMORIAL PKWY STE 104
SAINT PETERS MO
63376-2298
US

IV. Provider business mailing address

PO BOX 7412025
CHICAGO IL
60674-2025
US

V. Phone/Fax

Practice location:
  • Phone: 636-939-3362
  • Fax: 636-939-3687
Mailing address:
  • Phone: 636-939-3362
  • Fax: 636-939-3687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2001009157
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: