Healthcare Provider Details

I. General information

NPI: 1811932502
Provider Name (Legal Business Name): LAWRENCE G MENDELOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 04/17/2025
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N NEW BALLAS RD DIV SURG COLON/RECTAL, STE 265
SAINT LOUIS MO
63141-6825
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-4644
  • Fax: 866-342-0133
Mailing address:
  • Phone: 314-991-4644
  • Fax: 866-342-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberR9J70
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: