MEDICARE: DR. GEORGE A LODOLY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	R4G76	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205828795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE A LODOLY MD

Provider Business Mailing Address
First Line	:	660 S EUCLID AVE
Second Line	:	CB 8054
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1010
Country	:	US
Telephone Number	:	800-862-9980
Fax Number	:	314-362-1185

Provider Business Practice Location Address
First Line	:	10 HOSPITAL DR
Second Line	:	DEPT ANESTHESIOLOGY
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1659
Country	:	US
Telephone Number	:	800-862-9980
Fax Number	:	314-362-1185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	11/15/2021

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