# PHYSICIANS HEALTH GROUP MEDICAL INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245642420
- **Authorized official:** MR. CHRISTOPHER KAVANAUGH (OWNER)
- **Authorized official phone:** (636) 305-2000

## Contact information

- **Practice address:** 960 S. HIGHWAY DR, FENTON, MO 63026
- **Practice address phone:** (636) 305-2000
- **Practice address fax:** (314) 584-7007
- **Mailing address:** P.O. BOX 970, CHESTERFIELD, MO 63006
- **Mailing address phone:** (636) 305-2000
- **Mailing address fax:** (314) 584-7007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | MO | — |
| 208VP0000X | Pain Medicine Physician | — | MO | Yes |

## Other

- **Enumeration date:** 05/22/2014
- **Last updated:** 06/01/2015