Individual
DR. LAWRENCE BRUCE IKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
15410 MANCHESTER RD, ELLISVILLE, MO 63011-3029
(636) 227-6477
(636) 227-6477
Mailing address
15410 MANCHESTER RD, ELLISVILLE, MO 63011-3029
(636) 227-6477
(636) 227-6477
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
016002757
IL
213E00000X
Podiatrist
Primary
360
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972614451
—
MO
05
—
300900511
—
MO
01
—
P01144931
RAILROAD MEDICARE
IL
01
—
P01302987
RAILROAD MEDICARE
MO
Enumeration date
08/31/2006
Last updated
06/09/2014
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