Individual
LAVEENA MARIAM JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4523 CLAYTON AVE, SAINT LOUIS, MO 63110-1501
(314) 454-8293
(313) 343-8747
Mailing address
4523 CLAYTON AVE, SAINT LOUIS, MO 63110-1501
(314) 454-8293
(314) 454-5392
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4351049012
MI
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Enumeration date
03/23/2022
Last updated
06/13/2025
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