MEDICARE: ILLUMINATION HEALTH, LLC

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	2083B0002X	Obesity Medicine (Preventive Medicine) Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1992378384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLUMINATION HEALTH, LLC

Provider Business Mailing Address
First Line	:	121 SAINT LUKES CENTER DR
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3518
Country	:	US
Telephone Number	:	636-685-7804
Fax Number	:	314-576-2344

Provider Business Practice Location Address
First Line	:	2355 DOUGHERTY FERRY RD STE 410
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-3325
Country	:	US
Telephone Number	:	314-835-4873
Fax Number	:	314-336-6475

Authorized Official
Title or Position	:	V.P. PHYSICIAN NETWORK
Name	:	JAMES SNIDER
Credential	:
Telephone Number	:	636-685-7804

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	03/05/2026

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Directions to “ILLUMINATION HEALTH, LLC ” Practice Location

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