Healthcare Provider Details

I. General information

NPI: 1336357367
Provider Name (Legal Business Name): JOCHEN KLAUS MARIA LENNERZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE NORTH SUITE B
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

4605 LINDELL BLVD APT. 904
SAINT LOUIS MO
63108-3717
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-1247
  • Fax:
Mailing address:
  • Phone: 314-361-5645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number2008020877
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number2008020877
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: