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General NPI Number Information
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NPI Number | 1972721025
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Entity Type | Organization
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Legal Business Name | LAKEVIEW MEDICAL GROUP INC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 11/05/2021
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Provider Practice Location Address
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Address Line | 830 WATERBURY FALLS DR STE 202
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City | O FALLON
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State | MO
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Zip | 63368-2215
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Country | US
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Telephone | 636-278-1670
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Fax |
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Provider Business Mailing Address
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Address Line | 1630 MARKET CENTER BLVD STE 201
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City | O FALLON
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State | MO
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Zip | 63368-8407
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Country | US
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Telephone | 636-397-4012
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Fax | 636-278-1670
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS F WRIGHT
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Credential |
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Telephone | 636-397-4012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 108025
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License Number State | MO
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