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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