Organization
PHYSICAL MEDICINE GROUP, LLC
Active
Organization
PHYSICAL MEDICINE GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WILLIAMS (PRESIDENT)
63627288888
Entity
Organization
Contact information
Practice address
8633 MEXICO RD, O FALLON, MO 63366-7506
(636) 272-8888
(636) 272-7385
Mailing address
8633 MEXICO RD, O FALLON, MO 63366-7506
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2006038287
MO
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
2006038287
MO
Other
Enumeration date
03/14/2012
Last updated
06/05/2012
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