Individual
LISA C BURNS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
16555 MANCHESTER RD, SUITE 100, WILDWOOD, MO 63040-1220
(636) 458-0646
Mailing address
16555 MANCHESTER RD, SUITE 100, WILDWOOD, MO 63040-1220
(636) 458-0646
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
101171
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080125644
RAILROAD MEDICARE
MO
05
—
1902870561
—
MO
Enumeration date
02/13/2006
Last updated
08/20/2014
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