MEDICARE: SAMUEL LUGO M.D., F.A.C.S.

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	2086S0129X	Vascular Surgery Physician	28888	MO

General Provider Information

NPI Number	:	1609961168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUEL LUGO M.D., F.A.C.S.

Provider Business Mailing Address
First Line	:	5213 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-3170
Country	:	US
Telephone Number	:	314-646-0478
Fax Number	:

Provider Business Practice Location Address
First Line	:	5213 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-3170
Country	:	US
Telephone Number	:	314-646-0478
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SAMUEL LUGO
Credential	:	M.D.
Telephone Number	:	314-646-0478

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	02/27/2009

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